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General NPI Number Information
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NPI Number | 1861550600
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Entity Type | Organization
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Legal Business Name | SOUTHWEST CENTER FOR FACIAL AND ORAL SURGERY
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 212 ROWLS DRIVE
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone | 601-249-0045
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Fax | 601-249-0105
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Provider Business Mailing Address
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Address Line | 212 ROWLS DRIVE
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone | 601-249-0045
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Fax | 601-249-0105
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC S LEWIS
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Credential | DMD
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Telephone | 601-249-0045
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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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