Provider Demographics
NPI:1225476716
Name:COWETA FAMILY DENTAL
Entity Type:Organization
Organization Name:COWETA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:918-289-9405
Mailing Address - Street 1:129 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-4101
Mailing Address - Country:US
Mailing Address - Phone:918-279-8880
Mailing Address - Fax:
Practice Address - Street 1:129 S BROADWAY
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-4101
Practice Address - Country:US
Practice Address - Phone:918-279-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty