Provider Demographics
NPI:1376271056
Name:MANISCALCO ORAL AND FACIAL SURGERY LLC
Entity Type:Organization
Organization Name:MANISCALCO ORAL AND FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MANISCALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:205-527-3091
Mailing Address - Street 1:101 HEATHERBROOKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8008
Mailing Address - Country:US
Mailing Address - Phone:205-991-9787
Mailing Address - Fax:
Practice Address - Street 1:101 HEATHERBROOKE PARK DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8008
Practice Address - Country:US
Practice Address - Phone:205-991-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery