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Organization
PROFESSIONAL DENTAL ALLIANCE OF JACKSONVILLE OZARK, PLLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF JACKSONVILLE OZARK, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN HOWARD MA (CREDENTIALING SPECIALIST)
(757) 576-5479
Entity
Organization
Contact information
Practice address
7768 OZARK DR STE 200, JACKSONVILLE, FL 32256-5839
(904) 442-6000
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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