Provider Demographics
NPI:1588775449
Name:OZARK ORAL & MAXILLOFACIAL SURGERY, PA
Entity type:Organization
Organization Name:OZARK ORAL & MAXILLOFACIAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-636-3979
Mailing Address - Street 1:591 HORSEBARN RD #100
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8760
Mailing Address - Country:US
Mailing Address - Phone:479-636-3979
Mailing Address - Fax:479-636-0800
Practice Address - Street 1:591 HORSEBARN RD #100
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8760
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:2006-08-31
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B530OtherBCBS
AR5B530OtherBCBS
AR5B530Medicare PIN