Provider Demographics
NPI:1700273208
Name:NORTH ALABAMA ORAL AND FACIAL SURGERY LLC
Entity type:Organization
Organization Name:NORTH ALABAMA ORAL AND FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:256-265-4950
Mailing Address - Street 1:44 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3045
Mailing Address - Country:US
Mailing Address - Phone:256-774-3535
Mailing Address - Fax:256-325-6145
Practice Address - Street 1:44 HUGHES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3045
Practice Address - Country:US
Practice Address - Phone:256-774-3535
Practice Address - Fax:256-325-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL255501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty