Provider Demographics
NPI:1043928054
Name:OZARK KIDS DENTISTRY
Entity Type:Organization
Organization Name:OZARK KIDS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-274-4441
Mailing Address - Street 1:820 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2023
Mailing Address - Country:US
Mailing Address - Phone:417-256-0155
Mailing Address - Fax:417-204-5770
Practice Address - Street 1:820 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2023
Practice Address - Country:US
Practice Address - Phone:417-256-0155
Practice Address - Fax:417-204-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400038778Medicaid