Provider Demographics
NPI:1467742072
Name:FRANCIS, BRETT VIRGEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:VIRGEL
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-3613
Mailing Address - Country:US
Mailing Address - Phone:918-968-1606
Mailing Address - Fax:918-968-1635
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-3613
Practice Address - Country:US
Practice Address - Phone:918-968-1606
Practice Address - Fax:918-968-1635
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200411270AMedicaid