Provider Demographics
NPI:1235265315
Name:ORAL SURGERY ASSOCIATES, PC
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES, PC
Other - Org Name:L. TED JONES, DMD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-492-6363
Mailing Address - Street 1:200 EAST SAND MOUNTAIN DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950
Mailing Address - Country:US
Mailing Address - Phone:256-878-1387
Mailing Address - Fax:
Practice Address - Street 1:200 EAST SAND MOUNTAIN DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-2328
Practice Address - Country:US
Practice Address - Phone:256-878-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU95359Medicare UPIN
ALT98270Medicare UPIN
ALU84216Medicare UPIN
ALT68741Medicare UPIN