Mid Michigan Oral Surgery Pc | |
325 W Lake Lansing Rd East Lansing MI 48823-8524 | |
(517) 337-9759 | |
(517) 337-8156 |
Full Name | Mid Michigan Oral Surgery Pc |
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Speciality | Dentist |
Location | 325 W Lake Lansing Rd, East Lansing, Michigan |
Authorized Official Name and Position | Vincent V Benivegna (DOCTOR OWNER VICE PRESIDENT) |
Authorized Official Contact | 5173379759 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mid Michigan Oral Surgery Pc 325 W Lake Lansing Rd East Lansing MI 48823-8524 Ph: (517) 337-9759 | Mid Michigan Oral Surgery Pc 325 W Lake Lansing Rd East Lansing MI 48823-8524 Ph: (517) 337-9759 |
NPI Number | 1174516413 |
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Provider Enumeration Date | 08/23/2005 |
Last Update Date | 06/25/2024 |
Medicare PECOS PAC ID | 3274504881 |
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Medicare Enrollment ID | O20040805000351 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174516413 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Provider Name | Mark E Beckman |
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Provider Type | Practitioner - Maxillofacial Surgery |
Provider Identifiers | NPI Number: 1932198835 PECOS PAC ID: 8527039197 Enrollment ID: I20120504000036 |
Provider Name | Vincent Vern Benivegna |
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Provider Type | Practitioner - Maxillofacial Surgery |
Provider Identifiers | NPI Number: 1326032988 PECOS PAC ID: 2567359052 Enrollment ID: I20120622000630 |
Provider Name | Sean E Pack |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1083901425 PECOS PAC ID: 5496043572 Enrollment ID: I20161005000183 |
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