Provider Demographics
NPI:1003507922
Name:ABBOTT, CARLEY JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:JO
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 GOLDEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6755
Mailing Address - Country:US
Mailing Address - Phone:405-255-0758
Mailing Address - Fax:
Practice Address - Street 1:2328 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-6804
Practice Address - Country:US
Practice Address - Phone:405-222-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice