Organization
GULF COAST ORAL & FACIAL SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT T WATTS, JR D.M.D. (PHYSICAIN/OWNER)
(228) 388-5925
Entity
Organization
Contact information
Practice address
1760 MEDICAL PARK DR, SUITE A, BILOXI, MS 39532-2131
(228) 388-5925
(228) 388-8153
Mailing address
1760 MEDICAL PARK DR, SUITE A, BILOXI, MS 39532-2131
(228) 388-5925
(228) 388-8153
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
852815
UNITED CONCORDIA
MS
Enumeration date
05/27/2006
Last updated
08/22/2020
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