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5238 W St Joe Hwy Suite 2 Lansing MI 48917-4085 | |
| (517) 323-1000 | |
| (517) 886-5566 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 5238 W St Joe Hwy, Lansing, Michigan |
| Authorized Official Name and Position | Jeffrey E Persico (OWNER) |
| Authorized Official Contact | 5173498383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4201 Okemos Rd Okemos MI 48864-3200 Ph: (517) 349-8383 | 5238 W St Joe Hwy Suite 2 Lansing MI 48917-4085 Ph: (517) 323-1000 |
| NPI Number | 1881797983 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 05/05/2015 |
| Medicare PECOS PAC ID | 0547349458 |
|---|---|
| Medicare Enrollment ID | O20080505000086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881797983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | John S Faber |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1487757563 PECOS PAC ID: 3971682881 Enrollment ID: I20080505000106 |
| Provider Name | Jeffrey E Persico |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1437252509 PECOS PAC ID: 0345329256 Enrollment ID: I20080505000122 |
| Provider Name | Ezio Francesco Novelli |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1558622712 PECOS PAC ID: 6406162973 Enrollment ID: I20180628002127 |
| Provider Name | Justine S Moe |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1104143833 PECOS PAC ID: 4880963917 Enrollment ID: I20180906002293 |
| Provider Name | Igor Makovey |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1730440983 PECOS PAC ID: 6507171444 Enrollment ID: I20190606002402 |
| Provider Name | Andrew Mark Baker |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1295148880 PECOS PAC ID: 2264747252 Enrollment ID: I20220728001929 |
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