| Gardendale Oral Surgery, P.c. | |
|
919 Sharit Ave Ste 201 Gardendale AL 35071 | |
| (205) 631-4004 | |
| (205) 631-4007 |
| Full Name | Gardendale Oral Surgery, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 919 Sharit Ave Ste 201, Gardendale, Alabama |
| Authorized Official Name and Position | Justin D Lackey (FRONT OFFICE) |
| Authorized Official Contact | 2565952131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gardendale Oral Surgery, P.c. 919 Sharit Ave Ste 201 Gardendale AL 35071-5008 Ph: (205) 631-4004 | Gardendale Oral Surgery, P.c. 919 Sharit Ave Ste 201 Gardendale AL 35071 Ph: (205) 631-4004 |
| NPI Number | 1336632561 |
|---|---|
| Provider Enumeration Date | 06/12/2018 |
| Last Update Date | 07/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336632561 | NPI | - | NPPES |
| 216971 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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