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General NPI Number Information
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NPI Number | 1548450794
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Entity Type | Organization
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Legal Business Name | ORAL & FACIAL SURGICAL CENTER
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 300 HOSPITAL DR
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City | COLUMBUS
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State | MS
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Zip | 39705-1921
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Country | US
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Telephone | 662-327-2100
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Fax | 662-327-2105
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Provider Business Mailing Address
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Address Line | 300 HOSPITAL DR
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City | COLUMBUS
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State | MS
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Zip | 39705-1921
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Country | US
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Telephone | 662-327-2100
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Fax | 662-327-2105
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Authorized Official
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Title or Position | PRESIDNET
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Name | JOHN EDGAR GRIFFIN JR.
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Credential | DMD
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Telephone | 662-327-2100
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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 | 1834-79
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License Number State | MS
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