Provider Demographics
NPI:1124219274
Name:BROKEN ARROW ENDODONTICS
Entity Type:Organization
Organization Name:BROKEN ARROW ENDODONTICS
Other - Org Name:BROKEN ARROW ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVE
Authorized Official - Middle Name:G
Authorized Official - Last Name:STRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-615-3600
Mailing Address - Street 1:4420 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4645
Mailing Address - Country:US
Mailing Address - Phone:918-615-3600
Mailing Address - Fax:918-615-3601
Practice Address - Street 1:4420 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4645
Practice Address - Country:US
Practice Address - Phone:918-615-3600
Practice Address - Fax:918-615-3601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROKEN ARROW ENDODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty