Provider Demographics
NPI:1417231887
Name:PROGRESSIVE DENTAL
Entity Type:Organization
Organization Name:PROGRESSIVE DENTAL
Other - Org Name:JACK D MCCALMON DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-632-5561
Mailing Address - Street 1:8283 S WALKER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9413
Mailing Address - Country:US
Mailing Address - Phone:405-632-5561
Mailing Address - Fax:405-632-6301
Practice Address - Street 1:8283 SOUTH WALKER
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-632-5561
Practice Address - Fax:405-632-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty