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General NPI Number Information
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NPI Number | 1548650625
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Entity Type | Organization
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Legal Business Name | EVERTS, LIVINGSTON AND MILLER SURGICAL SERVICES, PC
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 420 1ST ST N
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City | ALABASTER
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State | AL
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Zip | 35007-8707
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Country | US
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Telephone | 205-208-0167
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Fax |
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Provider Business Mailing Address
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Address Line | 420 1ST ST N
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City | ALABASTER
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State | AL
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Zip | 35007-8707
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Country | US
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Telephone | 205-208-0167
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | RYAN LIVINGSTON
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Credential | MD, DMD
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Telephone | 205-910-7404
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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 | 5471
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License Number State | AL
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