1. Home
  2. Directory
  3. Mississippi
  4. Vicksburg
  5. Dentist
  6. NPI Profile

SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC
NPI 1073784880
Dentist - Oral and Maxillofacial Surgery in Vicksburg, MS

Active since March 19, 2008
1205 MISSION PARK DR, VICKSBURG, MS 39180(601) 661-0034(601) 661-0367 Get Directions Write a Review

NPPES record last updated: March 19, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southern Oral And Maxillofacial Surgery Center, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC (NPI 1073784880) is a healthcare organization registered as an oral and maxillofacial surgery in Vicksburg, Mississippi and active in the NPI registry since March 2008. The organization lists Kevin Keith Keen, Surgeon/owner, as its authorized official.

NPPES Registry Identity

NPI1073784880
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameSOUTHERN ORAL AND MAXILLOFACIAL SURGERY CENTER, INC
Location Address1205 MISSION PARK DRVicksburg, MS 39180-3747
Mailing Address1205 Mission Park DrVicksburg, MS 39180-3747 · (601) 661-0034 · Fax (601) 661-0367
Phone(601) 661-0034
Fax(601) 661-0367
Organization SubpartNo
Authorized OfficialKevin Keith KeenSurgeon/owner · (601) 661-0034
Enumeration DateMarch 19, 2008
✔ NPI 1073784880 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in MS · 2951-96
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
1205 MISSION PARK DR, Vicksburg, MS 39180
Open in Google Maps ↗

Other Identifiers 1

Medicare UPINU80152MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KEVIN KEITH KEEN D.M.D.
Dentist (Oral and Maxillofacial Surgery)
1205 MISSION PARK DR
VICKSBURG, MS 39180
Warren County (601) 661-0034

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Oral And Maxillofacial Surgery Center, Inc's NPI number?

The NPI number for Southern Oral And Maxillofacial Surgery Center, Inc is 1073784880. It was assigned to this organization in the NPPES registry on March 19, 2008.

Where is Southern Oral And Maxillofacial Surgery Center, Inc located?

Southern Oral And Maxillofacial Surgery Center, Inc is located at 1205 Mission Park Dr, Vicksburg, MS 39180. The listed phone number is (601) 661-0034.

What is Southern Oral And Maxillofacial Surgery Center, Inc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Southern Oral And Maxillofacial Surgery Center, Inc was last updated on March 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.