Healthcare Provider Details

I. General information

NPI: 1871791228
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR SUITE 225
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR SUITE 225
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-7324
  • Fax: 601-366-0228
Mailing address:
  • Phone: 601-366-7324
  • Fax: 601-366-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DONALD L SEAGO
Title or Position: PRESIDENT
Credential: DDS
Phone: 601-366-7324