Provider Demographics
NPI:1083871768
Name:ALLIED DENTAL ASSOCIATES OF CHOCTAW PLLC
Entity Type:Organization
Organization Name:ALLIED DENTAL ASSOCIATES OF CHOCTAW PLLC
Other - Org Name:TRACY GASBARRA DDS PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GASBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-390-2000
Mailing Address - Street 1:2401 N HENNY RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-0265
Mailing Address - Country:US
Mailing Address - Phone:405-390-2000
Mailing Address - Fax:405-390-2018
Practice Address - Street 1:2401 N HENNEY RD
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8751
Practice Address - Country:US
Practice Address - Phone:405-390-2000
Practice Address - Fax:405-390-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty