Provider Demographics
NPI:1306214200
Name:LISA MILLER ORAL FACIAL SURGERY
Entity type:Organization
Organization Name:LISA MILLER ORAL FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD/MD
Authorized Official - Phone:205-789-5075
Mailing Address - Street 1:301 W. LAUREL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1920
Mailing Address - Country:US
Mailing Address - Phone:251-320-3205
Mailing Address - Fax:251-320-3204
Practice Address - Street 1:301 W. LAUREL AVENUE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1920
Practice Address - Country:US
Practice Address - Phone:251-320-3205
Practice Address - Fax:251-320-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL177379Medicaid