Provider Demographics
NPI:1306172143
Name:ORAL & FACIAL SURGERY CENTER OF TALLAHASSEE, P.A.
Entity type:Organization
Organization Name:ORAL & FACIAL SURGERY CENTER OF TALLAHASSEE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-386-4602
Mailing Address - Street 1:1702 RIGGINS RD
Mailing Address - Street 2:SUITE 1 & 2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5371
Mailing Address - Country:US
Mailing Address - Phone:850-386-4602
Mailing Address - Fax:850-386-4206
Practice Address - Street 1:3375 CAPITAL CIRCLE NE BLDG D
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4334
Practice Address - Country:US
Practice Address - Phone:850-386-4602
Practice Address - Fax:850-386-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK234Medicare PIN