Mid Michigan Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

MID MICHIGAN ORAL SURGERY PC

Practice address

325 W Lake Lansing Rd
East Lansing, MI 48823-8524

Phone

(517) 337-9759

Fax

(517) 337-8156

NPI assigned

Aug 23, 2005

Organization subpart

No

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

Authorized official

Name

Vincent V Benivegna, DDSNPI 1326032988

Title

Doctor Owner Vice President

Phone

(517) 337-9759

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Mid Michigan Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlotte, MI
  • NPI 1861650095

  O20040805000351

  Same enrollment
• Mid Michigan Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Ledge, MI
  • NPI 1942468186

  O20040805000351

  Same enrollment

Tax ID family

Mid Michigan Oral Surgery3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Mid Michigan Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlotte, MI
  • NPI 1861650095
  NPD tax ID
• Mid Michigan Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Ledge, MI
  • NPI 1942468186
  NPD tax ID

Practitioners 3

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

• Mark E Beckman, D.D.S.,M.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • East Lansing, MI
  • NPI 1932198835
  Medicare reassignment Care Compare group NPD
• Vincent Vern Benivegna, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • East Lansing, MI
  • NPI 1326032988
  Medicare reassignment NPD Authorized official
• Sean E Pack, DDS MD

  • Oral and Maxillofacial Surgery (Dentist)
  • East Lansing, MI
  • NPI 1083901425
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1174516413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W LAKE LANSING RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238524",
            "telephone_number": "517-337-9759",
            "fax_number": "517-337-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W LAKE LANSING RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238524",
            "telephone_number": "517-337-9759",
            "fax_number": "517-337-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID MICHIGAN ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "BENIVEGNA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "DOCTOR OWNER VICE PRESIDENT",
        "authorized_official_telephone_number": "517-337-9759",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.