Provider Demographics
NPI:1497427017
Name:OZARK MODERN DENTISTRY, PLLC
Entity Type:Organization
Organization Name:OZARK MODERN DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-620-4268
Mailing Address - Street 1:101 GRANT PLACE SUITE C
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745
Mailing Address - Country:US
Mailing Address - Phone:214-620-4268
Mailing Address - Fax:
Practice Address - Street 1:101 GRANT PLACE SUITE C
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:214-620-4268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental