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General NPI Number Information
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NPI Number | 1801920301
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4815 PAULSEN ST
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City | SAVANNAH
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State | GA
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Zip | 31405-4418
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Country | US
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Telephone | 912-352-2324
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Fax | 912-354-0935
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Provider Business Mailing Address
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Address Line | 4815 PAULSEN ST
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City | SAVANNAH
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State | GA
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Zip | 31405-4418
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Country | US
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Telephone | 912-352-2324
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Fax | 912-354-0935
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ELAINE LIEUPO CARTER
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Credential |
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Telephone | 912-352-2324
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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 | GA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #3
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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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