MEDICARE: ORAL AND MAXILLOFACIAL SURGERY ASSOC.PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3039	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972718898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL AND MAXILLOFACIAL SURGERY ASSOC.PA

Provider Business Mailing Address
First Line	:	1325 DRAYTON RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-5106
Country	:	US
Telephone Number	:	864-591-3500
Fax Number	:	864-591-2235

Provider Business Practice Location Address
First Line	:	1325 DRAYTON RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-5106
Country	:	US
Telephone Number	:	864-591-3500
Fax Number	:	864-591-2235

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	DR. CHARLES KEITH COX
Credential	:	DDS
Telephone Number	:	864-591-3500

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/13/2007

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