| Mid Michigan Oral Surgery Pc | |
|
325 W Lake Lansing Rd East Lansing MI 48823-8524 | |
| (517) 337-9759 | |
| (517) 337-8156 |
| Full Name | Mid Michigan Oral Surgery Pc |
|---|---|
| Speciality | Dentist |
| Location | 325 W Lake Lansing Rd, East Lansing, Michigan |
| Authorized Official Name and Position | Vincent V Benivegna (DOCTOR OWNER VICE PRESIDENT) |
| Authorized Official Contact | 5173379759 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid Michigan Oral Surgery Pc 325 W Lake Lansing Rd East Lansing MI 48823-8524 Ph: (517) 337-9759 | Mid Michigan Oral Surgery Pc 325 W Lake Lansing Rd East Lansing MI 48823-8524 Ph: (517) 337-9759 |
| NPI Number | 1174516413 |
|---|---|
| Provider Enumeration Date | 08/23/2005 |
| Last Update Date | 09/28/2011 |
| Medicare PECOS PAC ID | 3274504881 |
|---|---|
| Medicare Enrollment ID | O20040805000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174516413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Mark E Beckman |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1932198835 PECOS PAC ID: 8527039197 Enrollment ID: I20120504000036 |
| Provider Name | Vincent Vern Benivegna |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1326032988 PECOS PAC ID: 2567359052 Enrollment ID: I20120622000630 |
| Provider Name | Sean E Pack |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1083901425 PECOS PAC ID: 5496043572 Enrollment ID: I20161005000183 |
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