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Organization
SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC
Active
Organization
SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN KEITH KEEN DMD (SURGEON/OWNER)
(601) 661-0034
Entity
Organization
Contact information
Practice address
1205 MISSION PARK DR, VICKSBURG, MS 39180-3747
(601) 661-0034
(601) 661-0367
Mailing address
1205 MISSION PARK DR, VICKSBURG, MS 39180-3747
(601) 661-0034
(601) 661-0367
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2951-96
MS
Other
Enumeration date
03/19/2008
Last updated
03/19/2008
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