MEDICARE: TOAFS LLC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1801685888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOAFS LLC

Provider Business Mailing Address
First Line	:	3700 INGLESIDE BLVD
Second Line	:
City	:	LADSON
State	:	SC
Zip	:	29456-4141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3321
Country	:	US
Telephone Number	:	813-238-0411
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE MANAGEMENT
Name	:	JACKIE HOLLOWAY
Credential	:
Telephone Number	:	854-200-7970

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	02/04/2026

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