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General NPI Number Information
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NPI Number | 1912123159
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Entity Type | Organization
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Legal Business Name | THE ORAL & MAXILLOFACIAL SURGERY CENTER, P.A.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 S 13TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4342
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Country | US
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Telephone | 601-425-2356
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Fax | 601-426-9038
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Provider Business Mailing Address
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Address Line | 325 S 13TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4342
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Country | US
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Telephone | 601-425-2356
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Fax | 601-426-9038
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | HEATHER HOOD
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Credential |
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Telephone | 601-425-2356
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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 | OS-082-84
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | OS-287-95
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License Number State | MS
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