Healthcare Provider Details

I. General information

NPI: 1306172143
Provider Name (Legal Business Name): ORAL & FACIAL SURGERY CENTER OF TALLAHASSEE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 CAPITAL CIRCLE NE BLDG D SUITE 2
TALLAHASSEE FL
32308-4334
US

IV. Provider business mailing address

1702 RIGGINS RD SUITE 1 & 2
TALLAHASSEE FL
32308-5371
US

V. Phone/Fax

Practice location:
  • Phone: 850-386-4602
  • Fax: 850-386-4206
Mailing address:
  • Phone: 850-386-4602
  • Fax: 850-386-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BARRETT TOLLEY
Title or Position: OWNER
Credential: DDS
Phone: 850-386-4602