Organization
MOSSY OAK DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN DALE FORD II DMD (DENTIST/OWNER)
(229) 436-7231
Entity
Organization
Contact information
Practice address
119 CARLTON DR, LEESBURG, GA 31763-5652
(229) 436-7231
Mailing address
PO BOX 71307, ALBANY, GA 31708-1307
(229) 436-7231
(229) 436-4423
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN012008
GA
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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