Provider Demographics
NPI:1558454751
Name:STRAHM, ELGIN RAY (DDS)
Entity Type:Individual
Prefix:
First Name:ELGIN
Middle Name:RAY
Last Name:STRAHM
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 1:106 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-3206
Mailing Address - Country:US
Mailing Address - Phone:918-787-6204
Mailing Address - Fax:918-787-6209
Practice Address - Street 1:106 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3206
Practice Address - Country:US
Practice Address - Phone:918-787-6204
Practice Address - Fax:918-787-6209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK34141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice