| Keystone Oral And Maxillofacial Surgery Pc | |
|
36975 Utica Rd Suite 106 Clinton Township MI 48036-1685 | |
| (586) 226-2801 | |
| (586) 226-1519 |
| Full Name | Keystone Oral And Maxillofacial Surgery Pc |
|---|---|
| Speciality | Dentist |
| Location | 36975 Utica Rd, Clinton Township, Michigan |
| Authorized Official Name and Position | Anthony E Kasper (OWNER) |
| Authorized Official Contact | 5869140093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keystone Oral And Maxillofacial Surgery Pc 36975 Utica Rd Suite 106 Clinton Township MI 48036-1685 Ph: (586) 226-2801 | Keystone Oral And Maxillofacial Surgery Pc 36975 Utica Rd Suite 106 Clinton Township MI 48036-1685 Ph: (586) 226-2801 |
| NPI Number | 1427457191 |
|---|---|
| Provider Enumeration Date | 08/19/2014 |
| Last Update Date | 10/27/2014 |
| Medicare PECOS PAC ID | 3577782663 |
|---|---|
| Medicare Enrollment ID | O20140923001186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427457191 | NPI | - | NPPES |
| 0E04308 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2901017390 (Michigan) | Primary |
| Provider Name | Anthony E Kasper |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1912990318 PECOS PAC ID: 7618030636 Enrollment ID: I20101210001044 |
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