Provider Demographics
NPI:1124178348
Name:POORE, CHRIS ALAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ALAN
Last Name:POORE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 N. MAY AVE.
Mailing Address - Street 2:
Mailing Address - City:OKLA. CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-947-0486
Mailing Address - Fax:405-942-4392
Practice Address - Street 1:9112 N. MAY AVE.
Practice Address - Street 2:
Practice Address - City:OKLA. CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-947-0486
Practice Address - Fax:405-942-4392
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist