Provider Demographics
NPI:1831433556
Name:ALABAMA ORAL AND FACIAL SURGERY LLC
Entity type:Organization
Organization Name:ALABAMA ORAL AND FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:205-682-1099
Mailing Address - Street 1:2290 VALLEYDALE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2011
Mailing Address - Country:US
Mailing Address - Phone:205-682-1099
Mailing Address - Fax:205-403-7383
Practice Address - Street 1:2290 VALLEYDALE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2011
Practice Address - Country:US
Practice Address - Phone:205-682-1099
Practice Address - Fax:205-403-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty