Provider Demographics
NPI:1336295427
Name:ROBERT BRYAN CRITTENDEN DDS PC
Entity Type:Organization
Organization Name:ROBERT BRYAN CRITTENDEN DDS PC
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-696-2542
Mailing Address - Street 1:704 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-4820
Mailing Address - Country:US
Mailing Address - Phone:918-696-2542
Mailing Address - Fax:
Practice Address - Street 1:704 S 2ND ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4820
Practice Address - Country:US
Practice Address - Phone:918-696-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty