NPIMap

Organization Active NPI

West Shore Oral & Maxillofacial Surgery Associates, PLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Norton Shores, MI
National Provider Identifier
1053458604
Registry record updated Jun 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
B7708N Issued in MI
Legal business name
WEST SHORE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, PLC
Practice address
5957 Harvey St
Norton Shores, MI 49444-9737
Phone
(231) 733-1571
Fax
(231) 733-5228
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark T. Burye, DDSNPI 1033147723
Title
Owner
Phone
(231) 733-1571

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X B7708N MI Primary

Addresses

Primary practice location

5957 Harvey St
Norton Shores, MI 49444-9737

Mailing address

5957 Harvey St Ste 200
Norton Shores, MI 49444-6735
Phone (231) 733-1571

Other practice location 1

3603 W US Highway 10
Ludington, MI 49431-9662
Phone (231) 733-1571

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040927000295 MI Part B Supplier - Clinic/Group Practice 8426027525 Receives reassigned benefits from 3 practitioners
Practice locations: Norton Shores, MI

National Provider Directory

National Provider Directory

Locations

1150 E Sherman Blvd
Ste 1600
Muskegon, MI 49444
Phone (231) 733-1571

5957 Harvey St
Ste 200
Norton Shores, MI 49444
Phone (231) 733-1571

5957 Harvey St
Norton Shores, MI 49444
Phone (231) 733-1571

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1053458604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5957 HARVEY ST STE 200",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494446735",
            "telephone_number": "231-733-1571",
            "fax_number": "231-733-5228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5957 HARVEY ST",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494449737",
            "telephone_number": "231-733-1571",
            "fax_number": "231-733-5228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3603 W US Highway 10",
            "address_purpose": "LOCATION",
            "city": "Ludington",
            "state": "MI",
            "postal_code": "494319662",
            "country_code": "US",
            "telephone_number": "231-733-1571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WEST SHORE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "BURYE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-733-1571",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "B7708N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norton Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.