| Breakwater Oral And Maxillofacial Surgery Pllc | |
|
6207 Harvey St Ste A Norton Shores MI 49444-7861 | |
| (231) 220-0500 | |
| (231) 220-0300 |
| Full Name | Breakwater Oral And Maxillofacial Surgery Pllc |
|---|---|
| Speciality | Dentist |
| Location | 6207 Harvey St Ste A, Norton Shores, Michigan |
| Authorized Official Name and Position | Alexis Fairfield (INSURANCE COORDINATOR) |
| Authorized Official Contact | 2312200500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breakwater Oral And Maxillofacial Surgery Pllc 6207 Harvey St Ste A Norton Shores MI 49444-7861 Ph: (231) 220-0500 | Breakwater Oral And Maxillofacial Surgery Pllc 6207 Harvey St Ste A Norton Shores MI 49444-7861 Ph: (231) 220-0500 |
| NPI Number | 1487375218 |
|---|---|
| Provider Enumeration Date | 09/09/2022 |
| Last Update Date | 08/01/2023 |
| Medicare PECOS PAC ID | 0648632414 |
|---|---|
| Medicare Enrollment ID | O20230810001058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487375218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Joseph Robert Larson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710335872 PECOS PAC ID: 8123383320 Enrollment ID: I20230810001311 |
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West Shore Oral & Maxillofacial Surgery Associates, Plc Dental Clinic Medicare: Medicare Enrolled Practice Location: 5957 Harvey St, Norton Shores, MI 49444 Phone: 231-733-1571 Fax: 231-733-5228 | |
Taryn K. Harreld, D.d.s., M.s., Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3579 Henry St, Suite 120, Norton Shores, MI 49441 Phone: 231-733-4494 | |
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