BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC
NPI 1487375218
Dentist - Oral and Maxillofacial Surgery in Norton Shores, MI

Q: What is Breakwater Oral And 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 September 09, 2022

6207 HARVEY ST STE A, NORTON SHORES, MI 49444(231) 220-0500(231) 220-0300 Get Directions Write a Review

NPPES record last updated: August 1, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Breakwater Oral And Maxillofacial Surgery Pllc NPPES

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

BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC (NPI 1487375218) is a healthcare organization registered as an oral and maxillofacial surgery in Norton Shores, Michigan and active in the NPI registry since September 2022. The organization lists Alexis Fairfield, Insurance Coordinator, as its authorized official.

NPPES Registry Identity

NPI1487375218

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameBREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC

Location Address6207 HARVEY ST STE ANorton Shores, MI 49444-7861

Mailing Address6207 Harvey St Ste ANorton Shores, MI 49444-7861 · (231) 220-0500

Phone(231) 220-0500

Fax(231) 220-0300

Organization SubpartNo

Authorized OfficialAlexis FairfieldInsurance Coordinator · (231) 220-0500

Enumeration DateSeptember 9, 2022

Last NPPES UpdateAugust 1, 2023

NPPES CertifiedAugust 1, 2023

✔ NPI 1487375218 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

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.

6207 HARVEY ST STE A, Norton Shores, MI 49444

Open in Google Maps ↗

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Breakwater Oral And Maxillofacial Surgery Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Breakwater Oral And Maxillofacial Surgery PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Joseph Larson, DMD, MD

Oral Surgery

NPI 1710335872

6207 HARVEY ST STE A
Norton Shores, MI 49444

(231) 690-9083

✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Breakwater Oral And Maxillofacial Surgery PLLC's NPI number?

The NPI number for Breakwater Oral And Maxillofacial Surgery PLLC is 1487375218. It was assigned to this organization in the NPPES registry on September 9, 2022.

Where is Breakwater Oral And Maxillofacial Surgery PLLC located?

Breakwater Oral And Maxillofacial Surgery PLLC is located at 6207 Harvey St Ste A, Norton Shores, MI 49444. The listed phone number is (231) 220-0500.

What is Breakwater Oral And Maxillofacial Surgery PLLC's specialty?

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

Is Breakwater Oral And Maxillofacial Surgery PLLC enrolled in Medicare?

Yes. Breakwater Oral And Maxillofacial Surgery PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Breakwater Oral And Maxillofacial Surgery PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Oral Surgery) reassigns their Medicare billing to Breakwater Oral And Maxillofacial Surgery PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Breakwater Oral And Maxillofacial Surgery PLLC was last updated on August 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.