Provider Demographics
NPI:1972774883
Name:ORAL AND MAXILLOFACIAL SURGERY CENTER
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-329-0300
Mailing Address - Street 1:102 SOUTH HOUSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS,
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-329-0300
Mailing Address - Fax:478-329-9672
Practice Address - Street 1:102 SOUTH HOUSTON ROAD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS,
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-329-0300
Practice Address - Fax:478-329-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1223S0112X261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU69469Medicare UPIN