Organization
NORTH MISSISSIPPI ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN LYNN COSTELLO (OFFICE MANAGER)
(662) 842-8200
Entity
Organization
Contact information
Practice address
1043 S MADISON ST, TUPELO, MS 38801-6309
(662) 842-8200
(662) 844-3157
Mailing address
1043 S MADISON ST, TUPELO, MS 38801-6309
(662) 842-8200
(662) 844-3157
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
MS162174
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00063290
—
MS
05
—
00660372
—
MS
05
—
05021312
—
MS
05
—
0660076
—
MS
Enumeration date
07/29/2006
Last updated
08/22/2020
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