LAKE MICHIGAN ORAL & MAXILLOFACIAL SURGERY PLLC
NPI 1245544824
Dentist - Oral and Maxillofacial Surgery in Saint Joseph, MI

Q: What is Lake Michigan Oral & Maxillofacial Surgery PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since August 05, 2010

3950 HOLLYWOOD RD, 290, SAINT JOSEPH, MI 49085(405) 848-7974(405) 848-0033 Get Directions Write a Review

NPPES record last updated: August 5, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Lake Michigan Oral & Maxillofacial Surgery Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE MICHIGAN ORAL & MAXILLOFACIAL SURGERY PLLC (NPI 1245544824) is a healthcare organization registered as an oral and maxillofacial surgery in Saint Joseph, Michigan and active in the NPI registry since August 2010. The organization lists Lisa Keough, Credentialing Rep, as its authorized official.

NPPES Registry Identity

NPI1245544824

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameLAKE MICHIGAN ORAL & MAXILLOFACIAL SURGERY PLLC

Location Address3950 HOLLYWOOD RD, 290Saint Joseph, MI 49085-9151

Mailing Address3000 United Founders Blvd, 237Oklahoma City, OK 73112-3958 · (405) 848-7974 · Fax (405) 848-0033

Phone(405) 848-7974

Fax(405) 848-0033

Organization SubpartNo

Authorized OfficialLisa KeoughCredentialing Rep · (405) 848-7974

Enumeration DateAugust 5, 2010

✔ NPI 1245544824 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in MI · 2901018748

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

3950 HOLLYWOOD RD, Saint Joseph, MI 49085

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BENJAMIN T. WOOD

Obstetrics & Gynecology

3950 HOLLYWOOD RD, SUITE 100
SAINT JOSEPH, MI 49085

Berrien County (269) 429-8010

DR. YU-LAM CHRISTOPHER CHIU M.D.

Internal Medicine (Interventional Cardiology)

3950 HOLLYWOOD RD, SUITE 110
SAINT JOSEPH, MI 49085

Berrien County (269) 985-1000

AMENA IQBAL

Internal Medicine (Endocrinology, Diabetes & Metabolism)

3950 HOLLYWOOD RD
SAINT JOSEPH, MI 49085

Berrien County (269) 408-1600

LAKESIDE CANCER SPECIALISTS, PLLC

Clinic/Center (Oncology)

3950 HOLLYWOOD RD, SUITE 240
SAINT JOSEPH, MI 49085

Berrien County (269) 428-4411

DR. PHILIP JASHEWAY PT, AT

Physical Therapist

3950 HOLLYWOOD RD
SAINT JOSEPH, MI 49085

Berrien County (269) 556-7150

DR. JOHN L BARD MD

Obstetrics & Gynecology

3950 HOLLYWOOD RD, SUITE 100
SAINT JOSEPH, MI 49085

Berrien County (269) 429-8010

SPECTRUM HEALTH HOSPITALS

Pediatrics (Pediatric Hematology-Oncology)

3950 HOLLYWOOD RD, SUITE 240
SAINT JOSEPH, MI 49085

Berrien County (616) 267-1925

DR. THOMAS K POW M.D.

Internal Medicine (Interventional Cardiology)

3950 HOLLYWOOD RD, SUITE 110
SAINT JOSEPH, MI 49085

Berrien County (269) 985-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Michigan Oral & Maxillofacial Surgery PLLC's NPI number?

The NPI number for Lake Michigan Oral & Maxillofacial Surgery PLLC is 1245544824. It was assigned to this organization in the NPPES registry on August 5, 2010.

Where is Lake Michigan Oral & Maxillofacial Surgery PLLC located?

Lake Michigan Oral & Maxillofacial Surgery PLLC is located at 3950 Hollywood Rd 290, Saint Joseph, MI 49085. The listed phone number is (405) 848-7974.

What is Lake Michigan Oral & Maxillofacial Surgery PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

What insurance does Lake Michigan Oral & Maxillofacial Surgery PLLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Cross Blue Shield of Michigan Mutual Insurance Company and UnitedHealthcare list Lake Michigan Oral & Maxillofacial Surgery PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lake Michigan Oral & Maxillofacial Surgery PLLC was last updated on August 5, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.