Provider Demographics
NPI:1346939253
Name:ANCOG, DREXY PEARL TORRES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DREXY PEARL
Middle Name:TORRES
Last Name:ANCOG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DREXY PEARL
Other - Middle Name:DOBLAS
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13208 SAWTOOTH OAK RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-2156
Mailing Address - Country:US
Mailing Address - Phone:405-248-7026
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ FWY STE 1700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2759
Practice Address - Country:US
Practice Address - Phone:469-658-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice