| Name: | Lisa Miller Oral Facial Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 10 Oct 2014 (10 years ago) (Companies founded in October 2014) |
| Entity Number: | 000-320-065 |
| Register Number: | 000320065 |
| ZIP code: | 36535 (Companies in Baldwin, 36535) |
| County: | Baldwin |
| Place of Formation: | Calhoun County |
| Registered Office Street Address: | 301 W. LAUREL AVENUEFOLEY, AL 36535 |
| Authorized Capital: | 1000 @ $1.00 PV |
Activities
PERFORM ORAL & FACIAL SURGERY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306214200 | 2015-09-09 | 2021-06-11 | 301 W. LAUREL AVENUE, FOLEY, AL, 365351920, US | 301 W. LAUREL AVENUE, FOLEY, AL, 365351920, US | |||||||||||||||||||||
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| Phone | +1 251-320-3205 |
| Fax | 2513203204 |
Authorized person
| Name | LISA MILLER |
| Role | ORAL SURGEON |
| Phone | 2057895075 |
Taxonomy
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 177379 |
| State | AL |
| Name | Role |
|---|---|
| MILLER, LISA MD | Agent |
| Name | Role | Address |
|---|---|---|
| MILLER, LISA L | Director | 4314 KINGS MOUNTAIN RIDGEBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| MILLER, LISA L | Incorporator | 4314 KINGS MOUNTAIN RIDGEBIRMINGHAM, AL 35242 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
