Great Lakes Jaw Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901011345 Issued in MI

Legal business name

GREAT LAKES JAW SURGERY, PC

Practice address

2017 Eastcastle Dr SE
Suite C
Grand Rapids, MI 49508-8872

Phone

(616) 281-2370

Fax

(616) 281-2801

NPI assigned

Oct 28, 2008

Last updated

Jul 28, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert John Rosema, D.D.SNPI 1629140116

Title

Owner/ Oral Surgeon

Phone

(616) 281-2370

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Robert John Rosema, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Rapids, MI
  • NPI 1629140116
  Authorized official Same address or phone

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1326291816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 EASTCASTLE DR SE",
            "address_2": "SUITE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495088872",
            "telephone_number": "616-281-2370",
            "fax_number": "616-281-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 EASTCASTLE DR SE",
            "address_2": "SUITE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495088872",
            "telephone_number": "616-281-2370",
            "fax_number": "616-281-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES JAW SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "ROSEMA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/ ORAL SURGEON",
        "authorized_official_telephone_number": "616-281-2370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901011345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10-2978271",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesse Grazewski
• Great Lakes Behavioral Health PLC
• Great Lakes Chiropractic Partners (Great Lakes Functional Neurology)
• Great Lakes Dental Care P.C.
• Great Lakes Hearing
• Great Lakes Neurosurgical Associates, PC
• Great Lakes Neurosurgical Associates, PC
• Great Lakes Psychiatric Services, P.C.
• Great Lakes RPH Corp (Woodpointe Pharmacy Corp)
• Great Lakes Sleep Care PLLC

• Oral and Maxillofacial Surgery (Dentist) in Grand Rapids, MI
• Providers in Grand Rapids, 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 Jul 28, 2020; 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.