| Great Lakes Oral Surgery And Implants, P.c. | |
|
5417 Gateway Ctr Flint MI 48507-3980 | |
| (810) 424-0705 | |
| (810) 424-0750 |
| Full Name | Great Lakes Oral Surgery And Implants, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 5417 Gateway Ctr, Flint, Michigan |
| Authorized Official Name and Position | Samantha A Kern (CREDENTIALING & BILLING) |
| Authorized Official Contact | 8104240705 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Oral Surgery And Implants, P.c. 5417 Gateway Centre Blvd. Flint MI 48507-3980 Ph: (810) 424-0705 | Great Lakes Oral Surgery And Implants, P.c. 5417 Gateway Ctr Flint MI 48507-3980 Ph: (810) 424-0705 |
| NPI Number | 1902993819 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 08/28/2024 |
| Medicare PECOS PAC ID | 2567471980 |
|---|---|
| Medicare Enrollment ID | O20060413000057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902993819 | NPI | - | NPPES |
| 2594587 | Medicaid | MI | |
| 9752562480 | Other | MI | BLUE CROSS BLUE SHIELD |
| 4045904 | Medicaid | MI | |
| 975256759 | Other | MI | BLUE CROSS BLUE SHIELD |
| 4417670 | Medicaid | MI | |
| 195256547 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Robert C John |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1598765604 PECOS PAC ID: 1557303765 Enrollment ID: I20050527000399 |
| Provider Name | Ahmad-reza Noroozi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467609719 PECOS PAC ID: 0042655094 Enrollment ID: I20240229000706 |
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