Breakwater Oral and Maxillofacial Surgery PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC

Doing business as

Great Oaks Periodontics & Dental Implants

Practice address

1000 W University Dr Ste 207
Rochester, MI 48307-1875

Phone

(947) 222-1667

Fax

(947) 222-1647

NPI assigned

May 15, 2026

Last updated

Jun 15, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLCAs reported in NPPES

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

Authorized official

Name

Jenn Heritage

Title

Credentialing Manager

Phone

(402) 805-4516

Specialties & licenses 1

Addresses

Other names 1

• Great Oaks Periodontics & Dental Implants Doing business as

Tax ID family

Breakwater Oral and Maxillofacial Surgery PLLC2 organizations share this tax ID, including this one

Part of

Breakwater Oral and Maxillofacial Surgery PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Breakwater Oral and Maxillofacial Surgery PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Norton Shores, MI
  • NPI 1487375218
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Breakwater Oral and Maxillofacial Surgery PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Norton Shores, MI
  • NPI 1487375218
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Robert Larson, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Norton Shores, MI
  • NPI 1710335872
  NPD

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

{
    "created_epoch": "1778803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1114856226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W UNIVERSITY DR STE 207",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W UNIVERSITY DR STE 207",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071875",
            "telephone_number": "947-222-1667",
            "fax_number": "947-222-1647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC",
        "enumeration_date": "2026-05-15",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "HERITAGE",
        "authorized_official_first_name": "JENN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "402-805-4516"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Oaks Periodontics & Dental Implants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jasmine Marie Bollus, FNP
• Renee Patrice Boyle
• Bradley J. Gauthier, DDS, Ms, PC
• Kristin Dickhoner Brandstetter, RD
• Amanda Chivu Brannick, M.D.
• Nicole Briggs
• Brightpath Wellness LLC
• Louis Brisson, MD
• Lori A Broecker, M.S.N., R.N., C.N.P.
• Patricia Brooks, MD

• Periodontics in Rochester, MI
• Providers in Rochester, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.