Provider Demographics
NPI:1447060496
Name:FAMILY DENTISTRY OF THE OZARKS
Entity type:Organization
Organization Name:FAMILY DENTISTRY OF THE OZARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-404-9831
Mailing Address - Street 1:891 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-8850
Mailing Address - Country:US
Mailing Address - Phone:479-444-0202
Mailing Address - Fax:
Practice Address - Street 1:891 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-8850
Practice Address - Country:US
Practice Address - Phone:479-444-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty