| Hattiesburg Oral Surgery | |
|
1421 S 28th Ave Hattiesburg MS 39402-3108 | |
| (601) 264-7611 | |
| (601) 268-0693 |
| Full Name | Hattiesburg Oral Surgery |
|---|---|
| Speciality | Dentist |
| Location | 1421 S 28th Ave, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Sandra P Odom (ADMINISTRATOR) |
| Authorized Official Contact | 6012619317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hattiesburg Oral Surgery 1421 S 28th Ave Hattiesburg MS 39402-3108 Ph: (601) 264-7611 | Hattiesburg Oral Surgery 1421 S 28th Ave Hattiesburg MS 39402-3108 Ph: (601) 264-7611 |
| NPI Number | 1578596060 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 07/22/2020 |
| Medicare PECOS PAC ID | 2163501602 |
|---|---|
| Medicare Enrollment ID | O20080508000373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578596060 | NPI | - | NPPES |
| 06271376 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Bennett V York |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1417045386 PECOS PAC ID: 5496834939 Enrollment ID: I20120130000702 |
| Provider Name | Griffin H West |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053752642 PECOS PAC ID: 6103191473 Enrollment ID: I20171012001750 |
| Provider Name | James Alston Owen |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1164953188 PECOS PAC ID: 5890072250 Enrollment ID: I20231128000584 |
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