Provider Demographics
NPI:1548635048
Name:OZARK ORAL SURGERY GROUP, PLLC
Entity type:Organization
Organization Name:OZARK ORAL SURGERY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROCKACY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:479-636-3979
Mailing Address - Street 1:591 S HORSEBARN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8710
Mailing Address - Country:US
Mailing Address - Phone:479-636-3979
Mailing Address - Fax:479-636-0800
Practice Address - Street 1:591 S HORSEBARN RD STE 100
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8710
Practice Address - Country:US
Practice Address - Phone:479-636-3979
Practice Address - Fax:479-636-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty