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General NPI Number Information
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NPI Number | 1265561856
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN ORAL & MAXILLOFACIAL SURGERY CENTER INC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 347 RED CEDAR ST BUILDING 200
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City | BLUFFTON
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State | SC
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Zip | 29910-8906
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Country | US
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Telephone | 843-815-4546
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Fax |
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Provider Business Mailing Address
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Address Line | 347 RED CEDAR ST BUILDING 200
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City | BLUFFTON
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State | SC
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Zip | 29910-8906
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Country | US
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Telephone | 843-815-4546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL CHRISTOPHER SHIRLEY
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Credential | DMD
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Telephone | 843-815-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3290
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License Number State | SC
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