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General NPI Number Information
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NPI Number | 1770776155
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Entity Type | Organization
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Legal Business Name | ORAL AND FACIAL SURGERY CENTER OF TALLAHASSEE
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 3375 CAPITAL CIR NE BLDG D SUITE 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-3778
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Country | US
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Telephone | 850-386-4602
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Fax | 850-386-4206
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Provider Business Mailing Address
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Address Line | 3330 CAPITAL OAKS DR STE 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4513
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Country | US
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Telephone | 850-386-4602
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Fax | 850-386-4206
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Authorized Official
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Title or Position | ORAL SURGEON / DENTIST
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Name | DR. BARRETT R TOLLEY
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Credential | D.D.S.
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Telephone | 850-386-4602
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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 | DN17462
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License Number State | FL
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