Provider Demographics
NPI:1609615871
Name:SOUTHEASTERN-OMS, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN-OMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:334-792-2880
Mailing Address - Street 1:216 HEALTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1942
Mailing Address - Country:US
Mailing Address - Phone:334-792-2880
Mailing Address - Fax:334-712-0202
Practice Address - Street 1:216 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1942
Practice Address - Country:US
Practice Address - Phone:334-792-2880
Practice Address - Fax:334-712-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty