Provider Demographics
NPI:1982937454
Name:MICHIGAN CENTER FOR ORAL SURGERY
Entity Type:Organization
Organization Name:MICHIGAN CENTER FOR ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:FLEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:734-675-1520
Mailing Address - Street 1:22150 ALLEN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2271
Mailing Address - Country:US
Mailing Address - Phone:734-675-1520
Mailing Address - Fax:734-675-2118
Practice Address - Street 1:22150 ALLEN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2271
Practice Address - Country:US
Practice Address - Phone:734-675-1520
Practice Address - Fax:734-675-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty