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General NPI Number Information
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NPI Number | 1306172143
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Entity Type | Organization
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Legal Business Name | ORAL & FACIAL SURGERY CENTER OF TALLAHASSEE, P.A.
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 3375 CAPITAL CIRCLE NE BLDG D SUITE 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4334
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Country | US
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Telephone | 850-386-4602
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Fax | 850-386-4206
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Provider Business Mailing Address
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Address Line | 1702 RIGGINS RD SUITE 1 & 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5371
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Country | US
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Telephone | 850-386-4602
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Fax | 850-386-4206
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARRETT TOLLEY
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Credential | DDS
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Telephone | 850-386-4602
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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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