Healthcare Provider Details

I. General information

NPI: 1326425711
Provider Name (Legal Business Name): BRACES OF THE OZARKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 S PAYNE STEWART DR STE 100
BRANSON MO
65616-2792
US

IV. Provider business mailing address

PO BOX 24470
LITTLE ROCK AR
72221-4470
US

V. Phone/Fax

Practice location:
  • Phone: 417-414-0011
  • Fax:
Mailing address:
  • Phone: 501-781-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARK DAKE
Title or Position: OWNER
Credential:
Phone: 501-781-2777