Healthcare Provider Details

I. General information

NPI: 1538465992
Provider Name (Legal Business Name): OZARKS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MCCOY DR
HARRISON AR
72601-2417
US

IV. Provider business mailing address

1405 MCCOY DR
HARRISON AR
72601-2417
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-5030
  • Fax: 870-741-9112
Mailing address:
  • Phone: 870-741-5030
  • Fax: 870-741-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2454
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOE E BOWERS
Title or Position: ORTHODONTIST
Credential: DDS, PA
Phone: 870-741-5030