1326197880 NPI number — WEST MICHIGAN ORAL AND MAXILLOFACIAL SURGERY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326197880 NPI number — WEST MICHIGAN ORAL AND MAXILLOFACIAL SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST MICHIGAN ORAL AND MAXILLOFACIAL SURGERY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEST MICHIGAN ORAL SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326197880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 MICHIGAN AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49423-4951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-530-4710
Provider Business Mailing Address Fax Number:
616-530-0480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49423-4951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-530-4710
Provider Business Practice Location Address Fax Number:
616-530-0480
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LINDHOUT
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
616-530-4710

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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