Mossy Oak Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN012008 Issued in GA

Legal business name

MOSSY OAK DENTAL, LLC

Practice address

119 Carlton Dr
Leesburg, GA 31763-5652

Phone

(229) 436-7231

NPI assigned

Jun 27, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Alan Dale Ford II, DMD

Title

Dentist/Owner

Phone

(229) 436-7231

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1992290415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71307",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317081307",
            "telephone_number": "229-436-7231",
            "fax_number": "229-436-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 CARLTON DR",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317635652",
            "telephone_number": "229-436-7231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSSY OAK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-27",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "229-436-7231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN012008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristian Leighann Miller Burnfin, L.M.T.
• Benjamin John Miller, DMD
• Julia Elaine Miller, NP
• Moore Motivation PC LLC
• Marrianne Moss
• Karen W Nagy, CCC-SLP
• Maria Nelson
• Shanda Dejoi Newsome, M.D.
• Laura Brennan O'Lannerghty, PT, DPT
• Oakland Pharmacy, LLC

• Dental Clinic/Center in Leesburg, GA
• Providers in Leesburg, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.