Healthcare Provider Details

I. General information

NPI: 1497997795
Provider Name (Legal Business Name): OFS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N DEAN RD
AUBURN AL
36830-4027
US

IV. Provider business mailing address

747 N DEAN RD
AUBURN AL
36830-4027
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-3436
  • Fax:
Mailing address:
  • Phone: 334-749-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberMD28533
License Number StateAL

VIII. Authorized Official

Name: THOMAS HUGHES FUQUA JR.
Title or Position: OWNER
Credential: DMD, MD
Phone: 334-749-3436