| Splendent Implant Center | |
|
6123 Harvey St Norton Shores MI 49444-6728 | |
| (667) 458-9821 | |
| Not Available |
| Full Name | Splendent Implant Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6123 Harvey St, Norton Shores, Michigan |
| Authorized Official Name and Position | Christopher John Sortman (OWNER) |
| Authorized Official Contact | 4109083652 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Splendent Implant Center 6123 Harvey St Norton Shores MI 49444-6728 Ph: (667) 458-9821 | Splendent Implant Center 6123 Harvey St Norton Shores MI 49444-6728 Ph: (667) 458-9821 |
| NPI Number | 1891297057 |
|---|---|
| Provider Enumeration Date | 03/05/2018 |
| Last Update Date | 09/13/2019 |
| Medicare PECOS PAC ID | 9638433519 |
|---|---|
| Medicare Enrollment ID | O20180430001797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891297057 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Albert Wesley |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1073770855 PECOS PAC ID: 7315180320 Enrollment ID: I20180430001963 |
| Provider Name | Brian Patrick Schaefer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255425047 PECOS PAC ID: 1951684497 Enrollment ID: I20181126001329 |
| Provider Name | Michael S Laraway |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255365193 PECOS PAC ID: 9931430105 Enrollment ID: I20191021000230 |
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