Healthcare Provider Details

I. General information

NPI: 1073640785
Provider Name (Legal Business Name): ALABAMA ORAL & MAXILLOFACIAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 WOODMERE BLVD
MONTGOMERY AL
36106-2918
US

IV. Provider business mailing address

4590 WOODMERE BLVD
MONTGOMERY AL
36106-2918
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-2002
  • Fax: 334-271-4523
Mailing address:
  • Phone: 334-271-2002
  • Fax: 334-271-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2941
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM J GOEHRING
Title or Position: OWNER
Credential: DDS
Phone: 334-271-2002