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General NPI Number Information
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NPI Number | 1083662290
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Entity Type | Organization
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Legal Business Name | ORAL & FACIAL SURGERY OF THE SHOALS, L.L.C.
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 398 ASHE BLVD
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City | SHEFFIELD
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State | AL
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Zip | 35660-1729
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Country | US
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Telephone | 256-383-1499
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Fax | 256-383-9135
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Provider Business Mailing Address
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Address Line | 398 ASHE BLVD
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City | SHEFFIELD
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State | AL
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Zip | 35660-1729
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Country | US
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Telephone | 256-383-1499
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Fax | 256-383-9135
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CONNIE GARGIS MCILWAIN
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Credential |
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Telephone | 256-383-1499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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