Provider Demographics
NPI:1366745119
Name:ROCHESTER HILLS OMS, P.C.
Entity type:Organization
Organization Name:ROCHESTER HILLS OMS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OBRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-651-4202
Mailing Address - Street 1:1205 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1864
Mailing Address - Country:US
Mailing Address - Phone:248-651-4202
Mailing Address - Fax:
Practice Address - Street 1:1205 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1864
Practice Address - Country:US
Practice Address - Phone:248-651-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty