CENTRASOTA ORAL & MAXILLOFACIAL SURGEONS, P.A. - NPI 1598710477

Q: What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 1223S0112X and a focus in Oral and Maxillofacial Surgery.

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About Centrasota Oral & Maxillofacial Surgeons, P.a. NPPES

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

CENTRASOTA ORAL & MAXILLOFACIAL SURGEONS, P.A. (NPI 1598710477) is a healthcare organization registered as an oral and maxillofacial surgery in Saint Cloud, Minnesota and active in the NPI registry since May 2006. The organization lists Robert J Keck, President, as its authorized official.

NPPES Registry Identity

NPI1598710477

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameCENTRASOTA ORAL & MAXILLOFACIAL SURGEONS, P.A.

Location Address3950 VETERANS DR, SUITE 100Saint Cloud, MN 56303-3410

Mailing Address3950 Veterans Dr, Suite 100Saint Cloud, MN 56303-3410 · (320) 252-3611 · Fax (320) 252-7574

Phone(320) 252-3611

Fax(320) 252-7574

Organization SubpartNo

Authorized OfficialRobert J KeckPresident · (320) 252-3611

Enumeration DateMay 22, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1598710477 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

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.

3950 VETERANS DR, Saint Cloud, MN 56303

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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