# CENTRASOTA ORAL & MAXILLOFACIAL SURGEONS, P.A.

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

## Provider details

- **NPI number:** 1598710477
- **Authorized official:** ROBERT J KECK D.D.S., M.S. (PRESIDENT)
- **Authorized official phone:** (320) 252-3611

## Contact information

- **Practice address:** 3950 VETERANS DR, SUITE 100, SAINT CLOUD, MN 56303-3410
- **Practice address phone:** (320) 252-3611
- **Practice address fax:** (320) 252-7574
- **Mailing address:** 3950 VETERANS DR, SUITE 100, SAINT CLOUD, MN 56303-3410
- **Mailing address phone:** (320) 252-3611
- **Mailing address fax:** (320) 252-7574

## Taxonomy

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

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 08/22/2020