Provider Demographics
NPI:1013586676
Name:MARQUIS CENTER OF OKLAHOMA CITY PLLC
Entity Type:Organization
Organization Name:MARQUIS CENTER OF OKLAHOMA CITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:618-402-6622
Mailing Address - Street 1:4447 N CENTRAL EXPY STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4246
Mailing Address - Country:US
Mailing Address - Phone:618-402-6622
Mailing Address - Fax:
Practice Address - Street 1:MARQUIS CENTER OF OKLAHOMA CITY, PLLC
Practice Address - Street 2:13901 PARKWAY COMMONS SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-500-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery