Provider Demographics
NPI:1417122276
Name:JEFFREY C. DANNER, DDS, PLLC
Entity Type:Organization
Organization Name:JEFFREY C. DANNER, DDS, PLLC
Other - Org Name:KINGFISHER DENTAL DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS, PLLC
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:DANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-375-3857
Mailing Address - Street 1:901 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-5006
Mailing Address - Country:US
Mailing Address - Phone:405-375-3857
Mailing Address - Fax:
Practice Address - Street 1:901 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-5006
Practice Address - Country:US
Practice Address - Phone:405-375-3857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108540BMedicaid