Provider Demographics
NPI:1225329659
Name:PH DENTAL PLLC
Entity Type:Organization
Organization Name:PH DENTAL PLLC
Other - Org Name:DENTAL EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:KI
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-409-4342
Mailing Address - Street 1:2712 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-1806
Mailing Address - Country:US
Mailing Address - Phone:405-212-4549
Mailing Address - Fax:
Practice Address - Street 1:2712 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-1806
Practice Address - Country:US
Practice Address - Phone:405-212-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty