Provider Demographics
NPI:1073712949
Name:CATOOSA DENTAL CARE, PLC
Entity Type:Organization
Organization Name:CATOOSA DENTAL CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-266-3866
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-1227
Mailing Address - Country:US
Mailing Address - Phone:918-266-3866
Mailing Address - Fax:918-266-3880
Practice Address - Street 1:1755 N HIGHWAY 66
Practice Address - Street 2:SUITE # D
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2409
Practice Address - Country:US
Practice Address - Phone:918-266-3866
Practice Address - Fax:918-266-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty