Provider Demographics
NPI:1417232703
Name:RESTORE AND MORE INC
Entity Type:Organization
Organization Name:RESTORE AND MORE INC
Other - Org Name:RESTORE AND MORE MASTER CLINICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAROLIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-695-6673
Mailing Address - Street 1:1217 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2311
Mailing Address - Country:US
Mailing Address - Phone:918-695-6673
Mailing Address - Fax:918-747-6673
Practice Address - Street 1:1217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2311
Practice Address - Country:US
Practice Address - Phone:918-695-6673
Practice Address - Fax:918-747-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20641041C0700X
OK11015207R00000X
PA68501207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty