| Great Lakes Jaw Surgery, Pc | |
|
2017 Eastcastle Dr Se Suite C Grand Rapids MI 49508-8872 | |
| (616) 281-2370 | |
| (616) 281-2801 |
| Full Name | Great Lakes Jaw Surgery, Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2017 Eastcastle Dr Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Robert John Rosema (OWNER/ ORAL SURGEON) |
| Authorized Official Contact | 6162812370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Jaw Surgery, Pc 2017 Eastcastle Dr Se Suite C Grand Rapids MI 49508-8872 Ph: (616) 281-2370 | Great Lakes Jaw Surgery, Pc 2017 Eastcastle Dr Se Suite C Grand Rapids MI 49508-8872 Ph: (616) 281-2370 |
| NPI Number | 1326291816 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 07/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326291816 | NPI | - | NPPES |
| 10-2978271 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2901011345 (Michigan) | Primary |
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› Verified 2 days ago
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