GARDENDALE ORAL SURGERY, P.C. (NPI# 1336632561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336632561 |
| Entity Type | Organization |
| Organization Name | GARDENDALE ORAL SURGERY, P.C. |
| Practice Address |
919 Sharit Ave Ste 201 Gardendale AL 35071 |
| Mailing Address |
919 Sharit Ave Ste 201 Gardendale AL 35071-5008 |
| Practice Telephone | 2056314004 |
| Practice Fax Number | 2056314007 |
| Mailing Telephone | 2056314004 |
| Mailing Fax Number | 2056314007 |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-07-05 |
| Authorized Official Name | JUSTIN D LACKEY (FRONT OFFICE) |
| Authorized Official Telephone | 2565952131 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 216971 | 05 |
| Street Address |
919 SHARIT AVE STE 201 |
| City | GARDENDALE |
| State | AL |
| Zip Code | 35071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144705682 | Ragan Overby | Nurse Practitioner | 960 Mount Olive Parkway, Gardendale, AL 35071 | 2018-10-01 |
| 1639696859 | Hillary Neal Davis | Nurse Practitioner | 313 Fieldstown Rd Ste 103, Gardendale, AL 35071 | 2017-08-28 |
| 1306218367 | Gardendale Health Mart Pharmacy LLC | Pharmacy | 835 Odum Rd Ste 101, Gardendale, AL 35071 | 2015-10-29 |
| 1164891610 | Cherry Kelly | Pharmacist | 890 Odum Road, Gardendale, AL 35071 | 2015-09-15 |
| 1023420809 | Paul Mcdonald | Nurse Practitioner | 2334 Us Highway 31, Gardendale, AL 35071 | 2014-05-28 |
| 1285056671 | Andrea Brown | Physical Therapy Assistant | 420 Dean Lane, Gardendale, AL 35071 | 2014-01-20 |
| 1720328784 | Genesis Rehabilation | Skilled Nursing Facility | 420 Dean Drive, Gardendale, ALABAMA 35071 | 2013-02-27 |
| 1609036003 | Sarah Peters Cribbs | Internal Medicine | 210 Fieldstown Rd, Gardendale, AL 35071 | 2008-06-10 |
| 1548313422 | Brookwood Urgent Care, L.L.C. | Family Medicine | 2117 Decatur Highway, Suite 131, Gardendale, AL 35071 | 2007-01-22 |
| 1659434272 | Ritchie Wilson Dmd | Dentist | 210 Redmayne Rd., Gardendale, AL 35071 | 2006-12-18 |
| Find all providers in zip 35071 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275059941 | Birmingham Oms Oral Facial & Implant Surgery LLC | Dentist | 4244 Cahaba Heights Ct Ste 300, Vestavia, AL 35243-5711 | 2017-08-15 |
| 1407267321 | Walter Harris Wilson | Dentist | 2290 Valleydale Rd Ste 100, Hoover, AL 35244-2113 | 2014-05-13 |
| 1104168244 | David W Davis | Dentist | 901 Leighton Ave Ste 401, Anniston, AL 36207-5703 | 2013-03-26 |
| 1942575444 | Medwell Duncan Dental | Dentist | 2705 Pelham Pkwy, Pelham, AL 35124-1704 | 2012-03-15 |
| 1578855078 | David G Minto Jr. | Dentist | 19748 Greeno Rd, Fairhope, AL 36532-3836 | 2011-05-03 |
| 1134359664 | Florence Oral and Maxillofacial Surgery | Dentist | 154 Titan Drive, Florence, AL 35630 | 2009-07-17 |
| 1396991899 | Sam Enoch Pruett Jr. | Dentist | 2816 Bunny Ln Sw, Decatur, AL 35603-4250 | 2008-08-15 |
| 1124236047 | Thomas Hughes Fuqua Jr. | Dentist | 747 N Dean Rd, Auburn, AL 36830-4027 | 2007-05-21 |
| 1710196506 | Lisa Miller | Dentist | 1 Inverness Center Pkwy Ste 200, Birmingham, AL 35242-4865 | 2007-05-21 |
| 1255543161 | William Floyd Littlejohn Jr. | Dentist | 2023 Danville Park Dr Sw, Decatur, AL 35603-1833 | 2007-05-04 |
| Find all providers with the same taxonomy | ||||
| City | GARDENDALE |
| Zip Code | 35071 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.