Organization
ORAL & FACIAL SURGERY OF EAST ALABAMA, LLC
Active
Parent organization
ORAL & FACIAL SURGERY OF EAST ALABAMA, LLC
Other names
Oral & Facial Surgery of West Georgia
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORAL & FACIAL SURGERY OF EAST ALABAMA, LLC
Authorized official
THOMAS H FUQUA DMD, MD (MANAGING MEMBER)
(334) 749-3436
Entity
Organization
Contact information
Practice address
4405 N STADIUM DRIVE, SUITE A, COLUMBUS, GA 31909
(334) 749-3436
(334) 749-3233
Mailing address
747 N DEAN ROAD, AUBURN, AL 36830
(334) 749-3436
(334) 749-3233
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
MD28533
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003194410A
—
GA
Enumeration date
12/08/2017
Last updated
12/08/2017
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