Healthcare Provider Details

I. General information

NPI: 1487227492
Provider Name (Legal Business Name): SERENE ORAL SURGERY & IMPLANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PARKWAY BLVD
HATTIESBURG MS
39401-8879
US

IV. Provider business mailing address

26 PARKWAY BLVD
HATTIESBURG MS
39401-8879
US

V. Phone/Fax

Practice location:
  • Phone: 877-667-7669
  • Fax: 405-848-0033
Mailing address:
  • Phone: 877-667-7669
  • Fax: 405-848-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: CURTIS J BISHOP
Title or Position: OWNER
Credential: DDS MD
Phone: 877-667-7669