Southern Oral and Maxillofacial Surgery Center, Inc

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2951-96 Issued in MS

Legal business name

SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC

Practice address

1205 Mission Park Dr
Vicksburg, MS 39180-3747

Phone

(601) 661-0034

Fax

(601) 661-0367

NPI assigned

Mar 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Keith Keen, DMD

Title

Surgeon/Owner

Phone

(601) 661-0034

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1073784880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 MISSION PARK DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803747",
            "telephone_number": "601-661-0034",
            "fax_number": "601-661-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 MISSION PARK DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803747",
            "telephone_number": "601-661-0034",
            "fax_number": "601-661-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "KEEN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "SURGEON/OWNER",
        "authorized_official_telephone_number": "601-661-0034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MS",
            "license": "2951-96",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.