South Shore Oms PC
NPI #1861122871 in Brownstown Twp, Michigan
Provider Information
- NPI Number
- 1861122871
- Entity Type
- Organization
- Organization Name
- South Shore Oms PC
- Primary Specialty
- Clinic/Center - Oral and Maxillofacial Surgery
- Enumeration Date
- Jun 13, 2022
- Last Updated
- Jun 13, 2022
Practice Location
- Address
- 19249 ALLEN RD
- City
- Brownstown Twp
- State
- Michigan
- ZIP Code
- 48183-1189
- Phone
- (734) 479-2990
Authorized Official
- Name
- KELLY DOHERTY
- Title
- ADMINISTRATIVE
- Phone
- (734) 479-2990
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery |
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