Provider Demographics
NPI:1083815377
Name:HWE MARIGNY, PLC
Entity Type:Organization
Organization Name:HWE MARIGNY, PLC
Other - Org Name:EMERSON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:918-459-0092
Mailing Address - Street 1:800 W MISSION ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2599
Mailing Address - Country:US
Mailing Address - Phone:918-459-0092
Mailing Address - Fax:918-455-0270
Practice Address - Street 1:800 W MISSION ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2599
Practice Address - Country:US
Practice Address - Phone:918-459-0092
Practice Address - Fax:918-455-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKORTHO SPECIALTY #1531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty