Provider Demographics
NPI:1366701450
Name:SHELBY ORAL FACIAL SURGERY PC
Entity type:Organization
Organization Name:SHELBY ORAL FACIAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-208-0167
Mailing Address - Street 1:420 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8707
Mailing Address - Country:US
Mailing Address - Phone:205-208-0167
Mailing Address - Fax:800-244-8132
Practice Address - Street 1:420 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8707
Practice Address - Country:US
Practice Address - Phone:205-208-0167
Practice Address - Fax:800-244-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty