NPIMap

Organization Active NPI

South Mississippi Oral Surgery & Implant Center PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gulfport, MS
National Provider Identifier
1780466300
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
SOUTH MISSISSIPPI ORAL SURGERY & IMPLANT CENTER PLLC
Practice address
12231 Bernard Pkwy
Gulfport, MS 39503-5086
Phone
(601) 264-7611
Fax
(601) 268-0693
NPI assigned
Oct 18, 2023
Last updated
Oct 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Authorized official

Name
Dr. Bennett Van York, DDSNPI 1417045386
Title
Owner
Phone
(601) 264-7611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU Primary

Addresses

Primary practice location

12231 Bernard Pkwy
Gulfport, MS 39503-5086

Mailing address

1421 S 28TH Ave
Hattiesburg, MS 39402-3108
Phone (601) 264-7611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251203001195 MS Part B Supplier - Clinic/Group Practice 2860985314 Receives reassigned benefits from 1 practitioner
Practice locations: Gulfport, MS

National Provider Directory

National Provider Directory

Locations

12231 Bernard Pkwy
Gulfport, MS 39503
Phone (228) 687-1900

1421 S 28th Ave
Hattiesburg, MS 39402
Phone (601) 264-7611

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1780466300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611",
            "fax_number": "601-268-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12231 BERNARD PKWY",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395035086",
            "telephone_number": "601-264-7611",
            "fax_number": "601-268-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MISSISSIPPI ORAL SURGERY & IMPLANT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-264-7611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.