Midwest Oral and Maxillofacial Surgery P C

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

16892 Issued in MI

Legal business name

MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C

Practice address

358 E Chicago St
Suite 200-a
Coldwater, MI 49036-2072

Phone

(517) 279-1730

Fax

(517) 279-1736

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael L Iczkovitz, DDS

Title

President

Phone

(260) 484-9990

Specialties & licenses 1

Addresses

Tax ID family

Midwest Oral and Maxillofacial Surgery P C3 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.

• Midwest Oral and Maxillofacial Surgery P C

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia City, IN
  • NPI 1467507798
  NPD tax ID
• Midwest Oral and Maxillofacial Surgery P C

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Wayne, IN
  • NPI 1558416883
  NPD tax ID

Locations

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1649316183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 TRIER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154768",
            "telephone_number": "260-484-9990",
            "fax_number": "260-484-6573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 E CHICAGO ST",
            "address_2": "SUITE 200-A",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362072",
            "telephone_number": "517-279-1730",
            "fax_number": "517-279-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "ICZKOVITZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-484-9990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "16892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn W Merriman, DDS
• Rheanna Metz
• Michael L Sussex OD PC
• Michigan Anesthesia Associates PLLC
• Michigan Sleep Institute PLLC
• Ashley Anne Milks
• Aaron Michael Miller, D.C.
• Bailey Jo Miller, D.C.
• Hillary Miller
• Julia Helen Miller, LLBSW

• Oral and Maxillofacial Surgery (Dentist) in Coldwater, MI
• Providers in Coldwater, 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 26, 2009; 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.