Provider Demographics
NPI:1245597665
Name:SHOOP FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:SHOOP FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SHOOP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-872-9030
Mailing Address - Street 1:2443 W KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8964
Mailing Address - Country:US
Mailing Address - Phone:918-872-9030
Mailing Address - Fax:918-872-9040
Practice Address - Street 1:2443 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8964
Practice Address - Country:US
Practice Address - Phone:918-872-9030
Practice Address - Fax:918-872-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty