Provider Demographics
NPI:1497815971
Name:OKLAHOMA DENTAL-BROKEN ARROW
Entity Type:Organization
Organization Name:OKLAHOMA DENTAL-BROKEN ARROW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CASTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-840-5600
Mailing Address - Street 1:4801 RICHMOND SQ
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2058
Mailing Address - Country:US
Mailing Address - Phone:405-840-5600
Mailing Address - Fax:405-842-9954
Practice Address - Street 1:2234 W HOUSTON ST STE A
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3519
Practice Address - Country:US
Practice Address - Phone:918-251-0220
Practice Address - Fax:405-842-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty