| Oral And Facial Surgery Center | |
|
811 S 28th Ave Hattiesburg MS 39402-2602 | |
| (601) 261-2611 | |
| (601) 261-2711 |
| Full Name | Oral And Facial Surgery Center |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 811 S 28th Ave, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Whitney A Powell (OFFICE MANAGER) |
| Authorized Official Contact | 6012612611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral And Facial Surgery Center 811 S 28th Ave Hattiesburg MS 39402-2602 Ph: (601) 261-2611 | Oral And Facial Surgery Center 811 S 28th Ave Hattiesburg MS 39402-2602 Ph: (601) 261-2611 |
| NPI Number | 1043815855 |
|---|---|
| Provider Enumeration Date | 12/01/2020 |
| Last Update Date | 12/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043815855 | NPI | - | NPPES |
| 01951327 | Medicaid | MS | |
| 03972317 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Primary |
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