Provider Demographics
NPI:1568639623
Name:J RUSSELL DANNER DDS
Entity Type:Organization
Organization Name:J RUSSELL DANNER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-749-1676
Mailing Address - Street 1:4514 MEMORIAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5005
Mailing Address - Country:US
Mailing Address - Phone:405-749-1676
Mailing Address - Fax:405-749-1898
Practice Address - Street 1:4514 MEMORIAL CIR STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5005
Practice Address - Country:US
Practice Address - Phone:405-749-1676
Practice Address - Fax:405-749-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5165261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental