Provider Demographics
NPI:1437568730
Name:DENTAL PROFESSIONALS OF OK, PC
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF OK, PC
Other - Org Name:FAMILY DENTAL CARE OF OWASSO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:13101 E. 96TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4775
Mailing Address - Country:US
Mailing Address - Phone:918-928-4747
Mailing Address - Fax:918-928-4748
Practice Address - Street 1:13101 E. 96TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4775
Practice Address - Country:US
Practice Address - Phone:918-928-4747
Practice Address - Fax:918-928-4748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF OK, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty