Provider Demographics
NPI:1245340892
Name:ORAL & FACIAL SURGERY OF AL, PC
Entity type:Organization
Organization Name:ORAL & FACIAL SURGERY OF AL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-933-2773
Mailing Address - Street 1:1500 19TH ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-5628
Mailing Address - Country:US
Mailing Address - Phone:205-933-2773
Mailing Address - Fax:205-933-5147
Practice Address - Street 1:1500 19TH ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-5628
Practice Address - Country:US
Practice Address - Phone:205-933-2773
Practice Address - Fax:205-933-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty