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Grand Traverse Oral Surgery, P.c.
Oral and Maxillofacial Surgery (Dentist) in Traverse City, Michigan
NPI 1003095605

Grand Traverse Oral Surgery, P.c. is a Oral and Maxillofacial Surgery (Dentist) based in Traverse City, MI and is specialized in Oral and Maxillofacial Surgery. Grand Traverse Oral Surgery, P.c. practices in Traverse City, MI. The NPI Number for Grand Traverse Oral Surgery, P.c. is 1003095605 and holds a License No. (Michigan).

The current practice location address for Grand Traverse Oral Surgery, P.c. is 12776 S West Bay Shore Dr, Traverse City, MI and can be reached out via phone at 231-946-3512 and via fax at 231-946-1908.

Location: 12776 S West Bay Shore Dr, Traverse City, MI, 49684-5451
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1003095605
Provider Name
Grand Traverse Oral Surgery, P.c.
Credential
Provider Entity Type
Organization
Address
12776 S West Bay Shore Dr, Traverse City, MI, 49684-5451
Phone Number
231-946-3512
Fax Number
231-946-1908
Provider Enumeration Date
10/31/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0P21110 01 MI MEDICARE GROUP #
institution
Provider Business Practice Location Address Details
Address
12776 S West Bay Shore Dr
City
Traverse City
State
Michigan
Zip
49684-5451
Phone Number
231-946-3512
Fax Number
231-946-1908
person
Provider Business Mailing Address Details
Address
12776 S West Bay Shore Dr
City
Traverse City
State
Michigan
Zip
49684-5451
Phone Number
231-946-3512
Fax Number
231-946-1908
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
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Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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