Provider Demographics
NPI:1427821909
Name:OFS-EA, LLC
Entity type:Organization
Organization Name:OFS-EA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:334-749-3436
Mailing Address - Street 1:2971 CORPORATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7283
Mailing Address - Country:US
Mailing Address - Phone:334-749-3436
Mailing Address - Fax:
Practice Address - Street 1:2971 CORPORATE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7283
Practice Address - Country:US
Practice Address - Phone:334-749-3436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty