# SOUTH MISSISSIPPI ORAL SURGERY & IMPLANT CENTER PLLC

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

## Provider details

- **NPI number:** 1780466300
- **Authorized official:** DR. BENNETT VAN YORK DDS (OWNER)
- **Authorized official phone:** (601) 264-7611

## Contact information

- **Practice address:** 12231 BERNARD PKWY, GULFPORT, MS 39503-5086
- **Practice address phone:** (601) 264-7611
- **Practice address fax:** (601) 268-0693
- **Mailing address:** 1421 S 28TH AVE, HATTIESBURG, MS 39402-3108
- **Mailing address phone:** (601) 264-7611
- **Mailing address fax:** (601) 268-0693

## 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:** 10/18/2023
- **Last updated:** 10/18/2023