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General NPI Number Information
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NPI Number | 1376271056
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Entity Type | Organization
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Legal Business Name | MANISCALCO ORAL AND FACIAL SURGERY LLC
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 101 HEATHERBROOKE PARK DR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-8008
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Country | US
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Telephone | 205-991-9787
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Fax |
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Provider Business Mailing Address
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Address Line | 101 HEATHERBROOKE PARK DR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-8008
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Country | US
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Telephone | 205-991-9787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEE MICHAEL MANISCALCO
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Credential | MD, DMD
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Telephone | 205-527-3091
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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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