Provider Demographics
NPI:1487019071
Name:STONEWOOD HILLS ORAL MAXILLOFACIAL SURGERY, INC.
Entity Type:Organization
Organization Name:STONEWOOD HILLS ORAL MAXILLOFACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-229-0292
Mailing Address - Street 1:425 STONE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1026
Mailing Address - Country:US
Mailing Address - Phone:918-229-0292
Mailing Address - Fax:
Practice Address - Street 1:425 STONE WOOD DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1026
Practice Address - Country:US
Practice Address - Phone:918-229-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty