Mossy Oak Dental, LLC

NPI #1992290415 in Leesburg, Georgia

Provider Information

NPI Number: 1992290415
Entity Type: Organization
Organization Name: Mossy Oak Dental, LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jun 27, 2018
Last Updated: Jun 27, 2018

Practice Location

Address: 119 CARLTON DR
City: Leesburg
State: Georgia
ZIP Code: 31763-5652
Phone: (229) 436-7231

Authorized Official

Name: DR. ALAN DALE FORD II, DMD
Title: DENTIST/OWNER
Phone: (229) 436-7231

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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