Provider Demographics
NPI:1073612719
Name:DAVE'S ENTERPRISES
Entity Type:Organization
Organization Name:DAVE'S ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID GENTRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:580-759-6424
Mailing Address - Street 1:49167 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BYARS
Mailing Address - State:OK
Mailing Address - Zip Code:74831-7305
Mailing Address - Country:US
Mailing Address - Phone:580-759-6424
Mailing Address - Fax:580-759-3396
Practice Address - Street 1:49167 140TH ST
Practice Address - Street 2:
Practice Address - City:BYARS
Practice Address - State:OK
Practice Address - Zip Code:74831-7305
Practice Address - Country:US
Practice Address - Phone:580-759-6424
Practice Address - Fax:580-759-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty