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General NPI Number Information
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NPI Number | 1306521752
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Entity Type | Organization
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Legal Business Name | SAVANNAH ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 5010 PAULSEN ST
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City | SAVANNAH
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State | GA
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Zip | 31405-4513
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Country | US
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Telephone | 843-762-9028
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 INGLESIDE BLVD BLDG 100
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City | LADSON
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State | SC
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Zip | 29456-4141
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Country | US
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Telephone | 843-974-5236
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. LYNDA TYLER
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Credential |
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Telephone | 843-974-5236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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