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General NPI Number Information
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NPI Number | 1447643523
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Entity Type | Organization
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Legal Business Name | SHELBY ORAL FACIAL SURGERY
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 1 INVERNESS CENTER PKWY SUITE 200
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4817
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Country | US
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Telephone | 205-789-5075
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Fax | 205-558-5775
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Provider Business Mailing Address
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Address Line | 1 INVERNESS CENTER PKWY SUITE 200
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4817
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Country | US
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Telephone | 205-789-5075
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Fax | 205-558-5775
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. LISA L MILLER
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Credential | DMD, MD
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Telephone | 205-789-5075
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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 | 5364
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License Number State | AL
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