Third Coast Oral & Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

THIRD COAST ORAL & MAXILLOFACIAL SURGERY

Practice address

2119 64TH St SW
Byron Center, MI 49315-9409

Phone

(616) 217-3632

Fax

(616) 217-3634

NPI assigned

Feb 15, 2022

Last updated

Feb 15, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Annika Schott

Title

Financial Coordinator

Phone

(616) 583-7307

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Destiny Baker, FNP-C

  • Family Nurse Practitioner
  • Byron Center, MI
  • NPI 1609560614
  NPD
• Adam James Lytle, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Byron Center, MI
  • NPI 1770780330
  NPD
• Christopher Niquette

  • Oral and Maxillofacial Surgery (Dentist)
  • Byron Center, MI
  • NPI 1811378508
  NPD

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

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1902551351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2119 64TH ST SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493159409",
            "telephone_number": "616-217-3632",
            "fax_number": "616-217-3634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2119 64TH ST SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493159409",
            "telephone_number": "616-217-3632",
            "fax_number": "616-217-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD COAST ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-15",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "SCHOTT",
        "authorized_official_first_name": "ANNIKA",
        "authorized_official_title_or_position": "FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "616-583-7307"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1811378508",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811378508",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@thirdcoastoms.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "2119 64th St SW",
            "city": "Byron Center",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493159409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@thirdcoastoms.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "2119 64th St SW",
            "city": "Byron Center",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493159409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kenza Sumbal
• Tara Blury LLC
• Stephanie Kristen Teslaa
• Amy Tetreault-Blok
• Ashley Theeuwes
• Kelly Renee Thornton, D.C.
• Ryan D Thornton, D.C.
• Brianna Grace Timmer
• Timothy J. Tobolic, MD, PLLC
• Kaitlyn Marie Tobeler, LLBSW QIDP

• Oral and Maxillofacial Surgery Clinic/Center in Byron Center, MI
• Providers in Byron Center, MI by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.