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General NPI Number Information
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NPI Number | 1700273208
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Entity Type | Organization
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Legal Business Name | NORTH ALABAMA ORAL AND FACIAL SURGERY LLC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 44 HUGHES RD
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City | MADISON
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State | AL
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Zip | 35758-3045
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Country | US
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Telephone | 256-774-3535
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Fax | 256-325-6145
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Provider Business Mailing Address
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Address Line | 44 HUGHES RD
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City | MADISON
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State | AL
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Zip | 35758-3045
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Country | US
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Telephone | 256-774-3535
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Fax | 256-325-6145
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MR. JASON R MILLER
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Credential | DMD, MD
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Telephone | 256-265-4950
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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 | 25550
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License Number State | AL
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