Great Lakes Oral and Maxillofacial Surgery P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C.

Practice address

2325 Summit Park Dr Ste D
Petoskey, MI 49770-8774

Phone

(231) 487-1020

NPI assigned

Jun 17, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Robert Scott Sheperd, DDSNPI 1568456028

Title

Ceo/President

Phone

(231) 487-1020

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Robert Scott Sheperd, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Petoskey, MI
  • NPI 1568456028
  NPD (past) Authorized official
• Sean Joseph Stringer, D.D.S.

  • Dentist
  • Petoskey, MI
  • NPI 1134418205
  NPD

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1760008528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 SUMMIT PARK DR STE D",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708774",
            "telephone_number": "231-487-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 SUMMIT PARK DR STE D",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708774",
            "telephone_number": "231-487-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "SHEPERD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "231-487-1020",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenden Charles Grangood, DPT
• Great Lakes Cardiothoracic & Vascular Surgery PLLC
• Great Lakes Digestive Health Assc PC
• Great Lakes Ear Nose & Throat Specialists PC
• Great Lakes Neurology, PC
• Great Lakes TTC,LLC
• John K. Grebe, PSY.D.
• Charles R Green, PA-C
• Aaron Charles Greene, P.A.
• Amanda Danielle Greene

• Oral and Maxillofacial Surgery (Dentist) in Petoskey, MI
• Providers in Petoskey, 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 17, 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.