MEDICARE: LIVEOAK FAMILY DENTISTRY INC.

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	1223G0001X	General Practice Dentistry	3865	AL

General Provider Information

NPI Number	:	1801814157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVEOAK FAMILY DENTISTRY INC.

Provider Business Mailing Address
First Line	:	2227 DRAKE AVE SW
Second Line	:	10-A
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5199
Country	:	US
Telephone Number	:	256-882-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 DRAKE AVE SW
Second Line	:	10-A
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5199
Country	:	US
Telephone Number	:	256-882-2227
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEBORAH B LIVEOAK
Credential	:	D.M.D.
Telephone Number	:	256-882-2227

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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