Provider Demographics
NPI:1073769634
Name:ELBERT A. FRANKLIN, D.D.S.
Entity Type:Organization
Organization Name:ELBERT A. FRANKLIN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-622-6144
Mailing Address - Street 1:925 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4409
Mailing Address - Country:US
Mailing Address - Phone:580-622-6144
Mailing Address - Fax:580-622-5350
Practice Address - Street 1:925 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4409
Practice Address - Country:US
Practice Address - Phone:580-622-6144
Practice Address - Fax:580-622-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40641223G0001X
OK60281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100143590AMedicaid