Advanced Oral Surgery, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ADVANCED ORAL SURGERY, PLLC

Doing business as

Advanced Oral Surgery and Dental Implant Studio

Practice address

3855 Burton St SE Ste B
Grand Rapids, MI 49546-6147

Phone

(616) 369-0360

Fax

(616) 369-0361

NPI assigned

Mar 6, 2019

Organization subpart

No

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

Authorized official

Name

Mark Leonard Jesin, DDS

Title

Manager

Phone

(616) 369-0360

Specialties & licenses 1

Addresses

Other names 1

• Advanced Oral Surgery and Dental Implant Studio Doing business as

Locations

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1508324732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466147",
            "telephone_number": "616-369-0360",
            "fax_number": "616-369-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466147",
            "telephone_number": "616-369-0360",
            "fax_number": "616-369-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED ORAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "JESIN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "LEONARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "616-369-0360",
        "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": [
        {
            "organization_name": "Advanced Oral Surgery and Dental Implant Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Mar 6, 2019; 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.