Provider Demographics
NPI:1063457919
Name:BAY AREA ORAL SURGERY PC
Entity Type:Organization
Organization Name:BAY AREA ORAL SURGERY PC
Other - Org Name:ZIEMAN PFEFFLE & SHEPPARD DMD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-344-6191
Mailing Address - Street 1:5901 GRELOT RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3603
Mailing Address - Country:US
Mailing Address - Phone:251-344-6191
Mailing Address - Fax:251-344-6794
Practice Address - Street 1:5901 GRELOT RD
Practice Address - Street 2:BUILDING C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3603
Practice Address - Country:US
Practice Address - Phone:251-344-6191
Practice Address - Fax:251-344-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3814174400000X
AL4598174400000X
AL5437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000090524OtherBCBS OF AL
AL257083Medicaid
AL1021853899OtherMEDICARE PTAN SHEPPARD
AL000005454OtherBCBS
AL0000094869OtherBCBS OF AL
AL0000032729OtherBCBS OF AL
AL165624Medicaid
AL167941Medicaid