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General NPI Number Information
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NPI Number | 1134359664
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Entity Type | Organization
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Legal Business Name | FLORENCE ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 154 TITAN DRIVE
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City | FLORENCE
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State | AL
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Zip | 35630
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Country | US
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Telephone | 256-712-5096
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Fax | 256-712-5097
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Provider Business Mailing Address
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Address Line | 154 TITAN DRIVE
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City | FLORENCE
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State | AL
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Zip | 35630
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Country | US
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Telephone | 256-712-5096
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Fax | 256-712-5097
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DANIEL LEE MORRIS
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Credential | DMD, MD
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Telephone | 256-712-5096
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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 | 4975
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License Number State | AL
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