Provider Demographics
NPI:1083662290
Name:ORAL & FACIAL SURGERY OF THE SHOALS, L.L.C.
Entity Type:Organization
Organization Name:ORAL & FACIAL SURGERY OF THE SHOALS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:GARGIS
Authorized Official - Last Name:MCILWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-383-1499
Mailing Address - Street 1:398 ASHE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-1729
Mailing Address - Country:US
Mailing Address - Phone:256-383-1499
Mailing Address - Fax:256-383-9135
Practice Address - Street 1:398 ASHE BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-1729
Practice Address - Country:US
Practice Address - Phone:256-383-1499
Practice Address - Fax:256-383-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty