Breakwater Oral and Maxillofacial Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC

Practice address

6207 Harvey St Ste a
Norton Shores, MI 49444-7861

Phone

(231) 220-0500

Fax

(231) 220-0300

NPI assigned

Sep 9, 2022

Organization subpart

No

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

Authorized official

Name

Alexis Fairfield

Title

Insurance Coordinator

Phone

(231) 220-0500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Tax ID family

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

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

  • Periodontics
  • Rochester, MI
  • NPI 1114856226
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Breakwater Oral and Maxillofacial Surgery PLLC

  • Periodontics
  • Rochester, MI
  • NPI 1114856226
  NPPES parent name

Practitioners 1

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

• Joseph Robert Larson, DMD, MD

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

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

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1487375218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6207 HARVEY ST STE A",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447861",
            "telephone_number": "231-220-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6207 HARVEY ST STE A",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447861",
            "telephone_number": "231-220-0500",
            "fax_number": "231-220-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-09",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "FAIRFIELD",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "231-220-0500"
    },
    "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": []
}

• Kelly Bos, MA. CCC-SLP
• Matthew Allen Bowen, M.D.
• Alison Jean Boyer-Rood, DPT
• Michelle J Bray, FNP-C
• Caitlin M Brazda, DO
• Brianne Ferguson DDS PLLC
• Valerie Renee Brickner, AU.D.
• Bright Smiles Dental Care PLC
• Debora Lucille Bringedahl
• Wendy Lynn Briseno, LLPC

• Oral and Maxillofacial Surgery (Dentist) in Norton Shores, MI
• Providers in Norton Shores, 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 Aug 1, 2023; 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.