Healthcare Provider Details

I. General information

NPI: 1134359664
Provider Name (Legal Business Name): FLORENCE ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 TITAN DRIVE
FLORENCE AL
35630
US

IV. Provider business mailing address

154 TITAN DRIVE
FLORENCE AL
35630
US

V. Phone/Fax

Practice location:
  • Phone: 256-712-5096
  • Fax: 256-712-5097
Mailing address:
  • Phone: 256-712-5096
  • Fax: 256-712-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4975
License Number StateAL

VIII. Authorized Official

Name: DR. DANIEL LEE MORRIS
Title or Position: PHYSICIAN
Credential: DMD, MD
Phone: 256-712-5096