Provider Demographics
NPI:1831249010
Name:DR ALLEN LIGON ORAL&MAXILLOFACIAL SURGERY, PLLC
Entity type:Organization
Organization Name:DR ALLEN LIGON ORAL&MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LIGON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-236-5300
Mailing Address - Street 1:1121 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5101
Mailing Address - Country:US
Mailing Address - Phone:662-236-5300
Mailing Address - Fax:
Practice Address - Street 1:1121 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5101
Practice Address - Country:US
Practice Address - Phone:662-236-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty