Provider Demographics
NPI:1043502248
Name:OSSI, ALAN R (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:OSSI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11560 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:STE. #3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1425
Mailing Address - Country:US
Mailing Address - Phone:904-268-7557
Mailing Address - Fax:
Practice Address - Street 1:11560 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:STE. #3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-1425
Practice Address - Country:US
Practice Address - Phone:904-268-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL134241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics