| Southern Oral And Maxillofacial Surgery Center, Inc | |
|
1205 Mission Park Dr Vicksburg MS 39180-3747 | |
| (601) 661-0034 | |
| (601) 661-0367 |
| Full Name | Southern Oral And Maxillofacial Surgery Center, Inc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1205 Mission Park Dr, Vicksburg, Mississippi |
| Authorized Official Name and Position | Kevin Keith Keen (SURGEON/OWNER) |
| Authorized Official Contact | 6016610034 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Oral And Maxillofacial Surgery Center, Inc 1205 Mission Park Dr Vicksburg MS 39180-3747 Ph: (601) 661-0034 | Southern Oral And Maxillofacial Surgery Center, Inc 1205 Mission Park Dr Vicksburg MS 39180-3747 Ph: (601) 661-0034 |
| NPI Number | 1073784880 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 03/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073784880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2951-96 (Mississippi) | Primary |
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› Verified 3 days ago
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