Provider Demographics
NPI:1942468186
Name:MID MICHIGAN ORAL SURGERY
Entity type:Organization
Organization Name:MID MICHIGAN ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:517-627-4088
Mailing Address - Street 1:1040 CHARLEVOIX DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2417
Mailing Address - Country:US
Mailing Address - Phone:517-627-4088
Mailing Address - Fax:517-627-3908
Practice Address - Street 1:1040 CHARLEVOIX DR
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2417
Practice Address - Country:US
Practice Address - Phone:517-627-4088
Practice Address - Fax:517-627-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM18080Medicare PIN