OrganizationActive
Advanced Oral Surgery, PLLC
NPI 1508324732 · Oral and Maxillofacial Surgery (Dentist) · Grand Rapids, MI
Provider details
- NPI number
- 1508324732
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Authorized official
- Mark Jesin, Manager
Practice location
3855 Burton St Se Ste B
Grand Rapids, MI 49546-6147
Phone: (616) 369-0360
Fax: (616) 369-0361
Mailing address
3855 Burton St Se Ste B
Grand Rapids, MI 49546-6147
Registry dates
- Enumerated
- 2019-03-06
- Last updated
- 2019-03-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.