Provider Demographics
NPI:1588840128
Name:DAVID L. BOONE, DDS, INC.
Entity Type:Organization
Organization Name:DAVID L. BOONE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-323-1177
Mailing Address - Street 1:519 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3632
Mailing Address - Country:US
Mailing Address - Phone:580-323-1177
Mailing Address - Fax:580-323-1178
Practice Address - Street 1:519 S 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3632
Practice Address - Country:US
Practice Address - Phone:580-323-1177
Practice Address - Fax:580-323-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty