# SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073784880
- **Authorized official:** DR. KEVIN KEITH KEEN DMD (SURGEON/OWNER)
- **Authorized official phone:** (601) 661-0034

## Contact information

- **Practice address:** 1205 MISSION PARK DR, VICKSBURG, MS 39180-3747
- **Practice address phone:** (601) 661-0034
- **Practice address fax:** (601) 661-0367
- **Mailing address:** 1205 MISSION PARK DR, VICKSBURG, MS 39180-3747
- **Mailing address phone:** (601) 661-0034
- **Mailing address fax:** (601) 661-0367

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2951-96 | MS | Yes |

## Other

- **Enumeration date:** 03/19/2008
- **Last updated:** 03/19/2008