Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southern Oral and Maxillofacial Surgery Center, Inc

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1073784880

Southern Oral and Maxillofacial Surgery Center, Inc is an Oral and Maxillofacial Surgery (Dentist) in Vicksburg, Mississippi. Licensed in Mississippi. Registered with an NPI since 2008.

Licensed in
MS
In the registry since
2008
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1205 Mission Park Dr
Vicksburg, MS 39180-3747
Phone: (601) 661-0034
Fax: (601) 661-0367
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 2951-96 (MS)

Record details

NPI number1073784880
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kevin Keen — Surgeon/Owner · (601) 661-0034
NPI enumeratedMarch 19, 2008
Last updated in NPPESMarch 19, 2008
Mailing address1205 Mission Park Dr, Vicksburg, MS 39180-3747

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