Provider Demographics
NPI:1255485132
Name:BATH, JEANNIE MCGEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:MCGEE
Last Name:BATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:BRIDGET
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:222 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-4800
Mailing Address - Country:US
Mailing Address - Phone:405-232-8631
Mailing Address - Fax:
Practice Address - Street 1:222 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-4800
Practice Address - Country:US
Practice Address - Phone:405-232-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200076110AMedicaid