Provider Demographics
NPI:1538676846
Name:BROKEN ARROW FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:BROKEN ARROW FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-455-8899
Mailing Address - Street 1:423 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6450
Mailing Address - Country:US
Mailing Address - Phone:918-455-8899
Mailing Address - Fax:918-250-6743
Practice Address - Street 1:423 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6450
Practice Address - Country:US
Practice Address - Phone:918-455-8899
Practice Address - Fax:918-250-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty