Provider Demographics
NPI:1467591339
Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OKLAHOMA PC
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OKLAHOMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-463-0004
Mailing Address - Street 1:PO BOX 108811
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8811
Mailing Address - Country:US
Mailing Address - Phone:405-841-7686
Mailing Address - Fax:405-848-0033
Practice Address - Street 1:10900 HEFNER POINTE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5082
Practice Address - Country:US
Practice Address - Phone:405-463-0004
Practice Address - Fax:405-463-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3389 AND 49881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX ID
OK400522005Medicare ID - Type UnspecifiedMEDICARE GROUP