Provider Demographics
NPI:1972689305
Name:OZARK FAMILY DENTAL PC
Entity Type:Organization
Organization Name:OZARK FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-774-9329
Mailing Address - Street 1:415 A JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360
Mailing Address - Country:US
Mailing Address - Phone:334-774-9329
Mailing Address - Fax:334-774-7664
Practice Address - Street 1:415 A JAMES STREET
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360
Practice Address - Country:US
Practice Address - Phone:334-774-9329
Practice Address - Fax:334-774-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
796357OtherUNITED CONCORDIA INS
AL96344OtherBCBS INS