Provider Demographics
NPI:1508989997
Name:MODERN DAY DENTAL
Entity Type:Organization
Organization Name:MODERN DAY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BYBEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-376-9600
Mailing Address - Street 1:9551 NORTH OWASSO EXPRESSWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-376-9600
Mailing Address - Fax:918-376-9622
Practice Address - Street 1:9551 NORTH OWASSO EXPRESSWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-376-9600
Practice Address - Fax:918-376-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty