Provider Demographics
NPI:1467750745
Name:OZARK PREFERRED DENTAL GROUP
Entity Type:Organization
Organization Name:OZARK PREFERRED DENTAL GROUP
Other - Org Name:ROBERT REYNOLDS, D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-881-3220
Mailing Address - Street 1:3211 E BATTLEFIELD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4050
Mailing Address - Country:US
Mailing Address - Phone:417-881-3220
Mailing Address - Fax:417-881-6473
Practice Address - Street 1:3211 E BATTLEFIELD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4050
Practice Address - Country:US
Practice Address - Phone:417-881-3220
Practice Address - Fax:417-881-6473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015036122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty