Healthcare Provider Details

I. General information

NPI: 1043502248
Provider Name (Legal Business Name): ALAN R OSSI D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 OLD SAINT AUGUSTINE RD STE. #3
JACKSONVILLE FL
32258-1425
US

IV. Provider business mailing address

11560 OLD SAINT AUGUSTINE RD STE. #3
JACKSONVILLE FL
32258-1425
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-7557
  • Fax:
Mailing address:
  • Phone: 904-268-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: