Provider Demographics
NPI:1235548157
Name:MIRANDA L. RULEFORD FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MIRANDA L. RULEFORD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:LOUISA
Authorized Official - Last Name:RULEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-756-9595
Mailing Address - Street 1:500 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447
Mailing Address - Country:US
Mailing Address - Phone:918-756-9595
Mailing Address - Fax:918-756-7781
Practice Address - Street 1:500 E 8TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447
Practice Address - Country:US
Practice Address - Phone:918-756-9595
Practice Address - Fax:918-756-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1558475392Medicaid
OK1366484438Medicaid
OK1558475392Medicaid