Souhwest Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

6721 Issued in OK

Legal business name

SOUHWEST ORAL SURGERY PC

Practice address

3617 W Gore Blvd Ste B
Lawton, OK 73505-6373

Phone

(580) 355-6000

Fax

(580) 355-7060

NPI assigned

Aug 25, 2015

Organization subpart

No

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

Authorized official

Name

Stephanie Grigg

Title

Business Manager

Phone

(803) 556-0005

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571961600000",
    "number": "1134596166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 W GORE BLVD STE B",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056373",
            "telephone_number": "580-355-6000",
            "fax_number": "580-355-7060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 W GORE BLVD STE B",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056373",
            "telephone_number": "580-355-6000",
            "fax_number": "580-355-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUHWEST ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2019-10-25",
        "status": "A",
        "authorized_official_last_name": "GRIGG",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "803-556-0005"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "6721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "records@sworalsurgery.com",
            "affiliation": "N",
            "endpointDescription": "Secure Records",
            "address_1": "3617 W Gore Blvd Ste B",
            "city": "Lawton",
            "state": "OK",
            "country_code": "US",
            "postal_code": "735056373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joanna Lynn Sorenson, RN
• France Sorrell
• Renee Sosebee
• Wanda Marie Soto-Torres, B.S.
• Miranda Soto
• Andrea Southerland, DPH
• Southern Oklahoma Infectious Diseases Consultants, PC
• Southern Oklahoma Treatment Services
• Southern Oklahoma Treatment Services, Inc.
• Anna Southern

• Oral and Maxillofacial Surgery (Dentist) in Lawton, OK
• Providers in Lawton, OK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.