Healthcare Provider Details

I. General information

NPI: 1245340892
Provider Name (Legal Business Name): ORAL & FACIAL SURGERY OF AL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 19TH ST S SUITE 200
BIRMINGHAM AL
35205-5628
US

IV. Provider business mailing address

1500 19TH ST S SUITE 200
BIRMINGHAM AL
35205-5628
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2773
  • Fax: 205-933-5147
Mailing address:
  • Phone: 205-933-2773
  • Fax: 205-933-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. LISA E BROWN
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-933-2773