Provider Demographics
NPI:1013723592
Name:OXFORD MAXILLOFACIAL SURGERY, INC.
Entity type:Organization
Organization Name:OXFORD MAXILLOFACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-784-2721
Mailing Address - Street 1:2886 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5347
Mailing Address - Country:US
Mailing Address - Phone:662-236-7888
Mailing Address - Fax:
Practice Address - Street 1:218 S THOMAS ST STE 122
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5300
Practice Address - Country:US
Practice Address - Phone:662-690-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OXFORD MAXILLOFACIAL SURGERY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty