Organization
ORAL AND FACIAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WHITNEY A POWELL (OFFICE MANAGER)
(601) 261-2611
Entity
Organization
Contact information
Practice address
811 S 28TH AVE, HATTIESBURG, MS 39402-2602
(601) 261-2611
(601) 261-2711
Mailing address
811 S 28TH AVE, HATTIESBURG, MS 39402-2602
(601) 261-2611
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01951327
—
MS
05
—
03972317
—
MS
Enumeration date
12/01/2020
Last updated
12/21/2020
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