Provider Demographics
NPI:1285674390
Name:FAULK, STEVE RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:RALPH
Last Name:FAULK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 PARKLAWN DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4216
Mailing Address - Country:US
Mailing Address - Phone:405-732-2660
Mailing Address - Fax:405-732-3199
Practice Address - Street 1:2828 PARKLAWN DR
Practice Address - Street 2:SUITE 7
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4216
Practice Address - Country:US
Practice Address - Phone:405-732-2660
Practice Address - Fax:405-732-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice