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General NPI Number Information
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NPI Number | 1285984013
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Entity Type | Organization
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Legal Business Name | OZARKS FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1333 W OUTER 21 RD
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City | ARNOLD.
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State | MO
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Zip | 63010
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Country | US
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Telephone | 870-580-0521
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Fax |
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Provider Business Mailing Address
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Address Line | 1333W OUTER 21 ROAD
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City | ARNOLD
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State | MO
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Zip | 63010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | REBECCA LOWDEN
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Credential |
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Telephone | 870-580-0521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2006012741
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License Number State | MO
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