Provider Demographics
NPI:1881797983
Name:ORAL SURGERY ASSOCIATES OF LANSING PC
Entity type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF LANSING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERSICO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:517-349-8383
Mailing Address - Street 1:4201 OKEMOS RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3200
Mailing Address - Country:US
Mailing Address - Phone:517-349-8383
Mailing Address - Fax:517-349-5566
Practice Address - Street 1:5238 W ST JOE HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4085
Practice Address - Country:US
Practice Address - Phone:517-323-1000
Practice Address - Fax:517-886-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P56310Medicare PIN