Healthcare Provider Details

I. General information

NPI: 1548635048
Provider Name (Legal Business Name): OZARK ORAL SURGERY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 S HORSEBARN RD STE 100
ROGERS AR
72758-8710
US

IV. Provider business mailing address

591 S HORSEBARN RD STE 100
ROGERS AR
72758-8710
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-3979
  • Fax: 479-636-0800
Mailing address:
  • Phone: 479-636-3979
  • Fax: 479-636-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY W ROCKACY
Title or Position: OWNER
Credential: DMD, MD
Phone: 479-636-3979