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General NPI Number Information
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NPI Number | 1609615871
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN-OMS, LLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 216 HEALTHWEST DR
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City | DOTHAN
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State | AL
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Zip | 36303-1942
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Country | US
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Telephone | 334-792-2880
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Fax | 334-712-0202
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Provider Business Mailing Address
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Address Line | 216 HEALTHWEST DR
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City | DOTHAN
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State | AL
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Zip | 36303-1942
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Country | US
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Telephone | 334-792-2880
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Fax | 334-712-0202
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Authorized Official
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Title or Position | ORAL SURGEON/OWNER
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Name | DR. GREGORY C BESS
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Credential | DMD, MD
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Telephone | 334-792-2880
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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 |
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License Number State |
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