# THE CENTER FOR ORAL AND MAXILLOFACIAL SURGERY LLC

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

## Provider details

- **NPI number:** 1386763936
- **Authorized official:** JOHN SHEETS (ORAL SURGEON)
- **Authorized official phone:** (573) 785-8471

## Contact information

- **Practice address:** 936 IDA ST, POPLAR BLUFF, MO 63901-4210
- **Practice address phone:** (573) 785-8471
- **Mailing address:** 936 IDA ST, POPLAR BLUFF, MO 63901-4210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12546 | MO | Yes |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 08/22/2020