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General NPI Number Information
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NPI Number | 1972774883
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGERY CENTER
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 102 SOUTH HOUSTON ROAD
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City | WARNER ROBINS
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State | GA
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Zip | 31088
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Country | US
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Telephone | 478-329-0300
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Fax | 478-329-9672
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Provider Business Mailing Address
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Address Line | 102 SOUTH HOUSTON ROAD
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City | WARNER ROBINS
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State | GA
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Zip | 31088
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Country | US
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Telephone | 478-329-0300
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Fax | 478-329-9672
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT MAURICE CAREY
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Credential | D.M.D.
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Telephone | 478-329-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1223S0112X
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License Number State | GA
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