Organization
SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN KEITH KEEN DMD (SURGEON/OWNER)
(601) 661-0034
Entity
Organization
Contact information
Practice address
1205 MISSION PARK DR, VICKSBURG, MS 39180-3747
(601) 661-0034
(601) 661-0367
Mailing address
1205 MISSION PARK DR, VICKSBURG, MS 39180-3747
(601) 661-0034
(601) 661-0367
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2951-96
MS
Other
Enumeration date
03/19/2008
Last updated
03/19/2008
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