Organization
SOUHWEST ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GRIGG (BUSINESS MANAGER)
(803) 556-0005
Entity
Organization
Contact information
Practice address
3617 W GORE BLVD STE B, LAWTON, OK 73505-6373
(580) 355-6000
(580) 355-7060
Mailing address
3617 W GORE BLVD STE B, LAWTON, OK 73505-6373
(580) 355-6000
(580) 355-7060
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6721
OK
Other
Enumeration date
08/25/2015
Last updated
10/25/2019
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