Organization
SOUTH MISSISSIPPI MAXILLOFACIAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT T WATTS, JR DMD (ORAL PHYSICIAN/MEDICAL DIRECTOR)
(228) 388-5925
Entity
Organization
Contact information
Practice address
1760 MEDICAL PARK DR, SUITE B, BILOXI, MS 39532-2131
(228) 388-5925
(228) 388-8153
Mailing address
1760 MEDICAL PARK DR, SUITE B, BILOXI, MS 39532-2131
(228) 388-5925
(228) 388-8153
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1987800
—
MS
Enumeration date
05/17/2006
Last updated
08/22/2020
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