Provider Demographics
NPI:1457456451
Name:GARY M LEDFORD DDS PC
Entity Type:Organization
Organization Name:GARY M LEDFORD DDS PC
Other - Org Name:DENTAL ASSOCIATES OF THE OZARKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-889-5200
Mailing Address - Street 1:1935 E BATTLEFIELD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3801
Mailing Address - Country:US
Mailing Address - Phone:417-889-5200
Mailing Address - Fax:417-889-5200
Practice Address - Street 1:1935 E BATTLEFIELD
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3801
Practice Address - Country:US
Practice Address - Phone:417-889-5200
Practice Address - Fax:417-889-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty