Provider Demographics
NPI:1346465341
Name:CHILDREN'S DENTAL HEALTH CENTER, P.L.C.
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL HEALTH CENTER, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-249-0249
Mailing Address - Street 1:9006 E 62ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6371
Mailing Address - Country:US
Mailing Address - Phone:918-249-0249
Mailing Address - Fax:918-249-1055
Practice Address - Street 1:9006 E 62ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6371
Practice Address - Country:US
Practice Address - Phone:918-249-0249
Practice Address - Fax:918-249-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty