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RENAISSANCE ORAL SURGERY PC NPI 1235325499


NPI Information

NPI: 1235325499
Provider Name: RENAISSANCE ORAL SURGERY PC
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
20805 E 12 MILE RD
STE 110
ROSEVILLE, MI
ZIP 48066
Phone: (586) 778-2100
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RENAISSANCE ORAL SURGERY PC is an oral and maxillofacial surgery dentist in Roseville, MI. The provider is an oral and maxillofacial surgery dentist specialized in 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. RENAISSANCE ORAL SURGERY PC NPI is 1235325499. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

20805 E 12 MILE RD
STE 110
ROSEVILLE, MI
ZIP 48066
Phone: (586) 778-2100
Fax: (586) 778-2422

The provider's authorized official is Henry Bryan .
The authorized official title is President and has the following contact phone number (586) 778-2100.

The enumeration date for this NPI number is 9/21/2007 and was last updated on 10/1/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204E00000XOral & Maxillofacial SurgeryNo
22082S0099XPlastic SurgeryPlastic Surgery Within the Head and NeckNo
31223S0112XDentistOral and Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P00230001OTHERMICHIGANMEDICARE PROVIDER
2P00230001MEDICARE PIN
3975506164OTHERMICHIGANBC/BS MEDICARE ADVANTAGE
4128744OTHERMICHIGANCARE CHOICES
52856OTHERMICHIGANGOLDEN DENTAL
6975506164OTHERMICHIGANBC/BS OF MI
7U33701OTHERMICHIGANHAP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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