MEDICARE: DR. ALEXIS FERRELL PUGH DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0006528-C1	AL

General Provider Information

NPI Number	:	1801414834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS FERRELL PUGH DDS, MSD

Provider Business Mailing Address
First Line	:	6201 HARMON DR
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35128-6713
Country	:	US
Telephone Number	:	205-908-5884
Fax Number	:

Provider Business Practice Location Address
First Line	:	5391 MAGNOLIA TRCE
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-4622
Country	:	US
Telephone Number	:	205-628-9789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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