Great Lakes Oral Surgery PLLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

GREAT LAKES ORAL SURGERY PLLC

Doing business as

Wisdom Tooth & Dental Implant Center

Practice address

955 W Eisenhower Cir Ste G
Ann Arbor, MI 48103-5868

Phone

(269) 845-0671

NPI assigned

May 13, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Joshua Allen Deuel, DDSNPI 1831551472

Title

Owner/Operator

Phone

(269) 845-0671

Specialties & licenses 1

Addresses

Other names 1

• Wisdom Tooth & Dental Implant Center Doing business as

Locations

Practitioners 1

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

• Joshua Allen Deuel, D.D.S.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Ann Arbor, MI
  • NPI 1831551472
  NPD Authorized official

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1801644042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 S MAIN ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035830",
            "telephone_number": "269-845-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W EISENHOWER CIR STE G",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035868",
            "telephone_number": "269-845-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-12",
        "status": "A",
        "authorized_official_last_name": "DEUEL",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "269-845-0671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisdom Tooth & Dental Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Martha L Gray, MD
• Sommer Ann Marie Gray
• Steven Allen Gray, DDS
• Gregory P. Graziano, MD
• Great Lakes Bay Health Centers
• Great Lakes Teletherapy
• Great Lakes Wellness Group
• Jennifer R Greca, M.A. CCC-SLP
• Christina Krokosky Grech, M.D.
• John Anthony Greco, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.