| Southwest Virginia Oral & Maxillofacial Surgery, Pllc | |
|
1940 Braeburn Dr Suite A Salem VA 24153-7383 | |
| (540) 989-5257 | |
| (540) 989-5259 |
| Full Name | Southwest Virginia Oral & Maxillofacial Surgery, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1940 Braeburn Dr, Salem, Virginia |
| Authorized Official Name and Position | Samuel E Scroggins (LLC MEMBER) |
| Authorized Official Contact | 5409895257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Virginia Oral & Maxillofacial Surgery, Pllc 1940 Braeburn Dr Suite A Salem VA 24153-7383 Ph: (540) 989-5257 | Southwest Virginia Oral & Maxillofacial Surgery, Pllc 1940 Braeburn Dr Suite A Salem VA 24153-7383 Ph: (540) 989-5257 |
| NPI Number | 1972996197 |
|---|---|
| Provider Enumeration Date | 03/12/2015 |
| Last Update Date | 03/12/2015 |
| Medicare PECOS PAC ID | 0749592038 |
|---|---|
| Medicare Enrollment ID | O20150629002391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972996197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 0401413811 (Virginia) | Primary |
| Provider Name | Samuel E Scroggins |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1487742375 PECOS PAC ID: 7214179225 Enrollment ID: I20130803000169 |
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