Kalamazoo Oral & Maxillofacial Surgery, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

KALAMAZOO ORAL & MAXILLOFACIAL SURGERY, P.C.

Practice address

3801 Glenkerry CT
Portage, MI 49024-0718

Phone

(269) 323-1527

Fax

(269) 323-1670

NPI assigned

Oct 13, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Nancy Simonelli

Title

Office Manager

Phone

(269) 323-1527

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 7

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

• Christian L Kanar, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Portage, MI
  • NPI 1952361594
  Medicare reassignment Care Compare group NPD
• Michael Jeffrey Harrison

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Portage, MI
  • NPI 1972006914
  Medicare reassignment Care Compare group
• David M. Wilson, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Portage, MI
  • NPI 1376705038
  Medicare reassignment Care Compare group
• Eric Safranski, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Maywood, IL
  • NPI 1992151682

  MI

  Medicare reassignment Care Compare group
• Kevin Donald Morse, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Portage, MI
  • NPI 1164416194
  Medicare reassignment NPD
• Robert M Humphries, D.D.S., M.S.

  • Prosthodontics
  • Portage, MI
  • NPI 1912069204
  NPD (past)
• Timothy V Williams, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Portage, MI
  • NPI 1245291368
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1265522262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240718",
            "telephone_number": "269-323-1527",
            "fax_number": "269-323-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240718",
            "telephone_number": "269-323-1527",
            "fax_number": "269-323-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALAMAZOO ORAL & MAXILLOFACIAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "SIMONELLI",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "269-323-1527",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI T. SLACK",
            "identifier": "1669433793",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI D. WILSON",
            "identifier": "1376705038",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI K. MORSE",
            "identifier": "1164416194",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI C. KANAR",
            "identifier": "1952361594",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI J. GISSAL",
            "identifier": "1780645804",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kalamazoo Foot and Ankle Specialists, PLC
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• Kalamazoo Ophthalmology PC
• Kalamazoo Optometry PC
• Kalamazoo Valley Counseling and Therapy Supports
• Megan A Kamerman, LLMSW
• Michelle Kaminski
• Chethana Kanaparthi, M.D.
• Christian L Kanar, DDS

• Oral and Maxillofacial Surgery (Dentist) in Portage, MI
• Providers in Portage, 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 2, 2015; 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.