Provider Demographics
NPI:1285663575
Name:VIAN FAMILY DENTAL CLINIC, INC.
Entity Type:Organization
Organization Name:VIAN FAMILY DENTAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-773-6200
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962-0696
Mailing Address - Country:US
Mailing Address - Phone:918-773-6200
Mailing Address - Fax:918-773-6201
Practice Address - Street 1:HIGHWAY 82 SOUTH AND I40 JUNCTION
Practice Address - Street 2:
Practice Address - City:VIAN
Practice Address - State:OK
Practice Address - Zip Code:74962-0696
Practice Address - Country:US
Practice Address - Phone:918-773-6200
Practice Address - Fax:918-773-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty