Provider Demographics
NPI:1205838026
Name:AINSWORTH, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:AINSWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N FINANCIAL TER
Mailing Address - Street 2:STE. D
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4432
Mailing Address - Country:US
Mailing Address - Phone:405-376-2072
Mailing Address - Fax:405-376-2094
Practice Address - Street 1:500 N FINANCIAL TER
Practice Address - Street 2:STE. D
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4432
Practice Address - Country:US
Practice Address - Phone:405-376-2072
Practice Address - Fax:405-376-2094
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731222543-001OtherBLUE CROSS ASSIGNED NUMBE