Braces of the Ozarks, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

BRACES OF THE OZARKS, LLC

Doing business as

Branson Braces

Practice address

168 S Payne Stewart Dr
Ste 100
Branson, MO 65616-2792

Phone

(417) 414-0011

NPI assigned

May 5, 2015

Last updated

May 5, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Dake

Title

Owner

Phone

(501) 781-2777

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Branson Braces Doing business as

Tax ID family

Braces of the Ozarks LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Braces of the Ozarks, LLC

  dba Tatum Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Harrison, AR
  • NPI 1043609522
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1326425711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24470",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722214470",
            "telephone_number": "501-781-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 S PAYNE STEWART DR",
            "address_2": "STE 100",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656162792",
            "telephone_number": "417-414-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRACES OF THE OZARKS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "DAKE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-781-2777",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043609522",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Branson Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lance Hamilton Borup, D.O.
• Sarah Catherine Boss, CRNA
• Tanya Dian Bowden, R.D.
• Julia Shreder Bowers, RPH
• Rebecca Anne Bowman, LCSW
• Branson Braces LLC (Branson Braces)
• Branson Chiropractic Center P.C.
• Branson Clinic, LLC
• Branson Clinic, LLC
• Branson Dialysis, LLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Branson, MO
• Providers in Branson, MO by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.