| Souhwest Oral Surgery Pc | |
|
3617 W Gore Blvd Ste B Lawton OK 73505-6373 | |
| (580) 355-6000 | |
| (580) 355-7060 |
| Full Name | Souhwest Oral Surgery Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3617 W Gore Blvd Ste B, Lawton, Oklahoma |
| Authorized Official Name and Position | Stephanie Grigg (BUSINESS MANAGER) |
| Authorized Official Contact | 8035560005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Souhwest Oral Surgery Pc 3617 W Gore Blvd Ste B Lawton OK 73505-6373 Ph: (580) 355-6000 | Souhwest Oral Surgery Pc 3617 W Gore Blvd Ste B Lawton OK 73505-6373 Ph: (580) 355-6000 |
| NPI Number | 1134596166 |
|---|---|
| Provider Enumeration Date | 08/25/2015 |
| Last Update Date | 10/25/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134596166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 6721 (Oklahoma) | Primary |
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