Provider Demographics
NPI:1609142827
Name:BOARD OF REGENTS OF OK - COL OF DENTISTRY GRAD PERODONTICS
Entity Type:Organization
Organization Name:BOARD OF REGENTS OF OK - COL OF DENTISTRY GRAD PERODONTICS
Other - Org Name:COL OF DENTISTRY GRAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR RESARCH ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-2090
Mailing Address - Street 1:PO BOX 26901
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0901
Mailing Address - Country:US
Mailing Address - Phone:405-271-6531
Mailing Address - Fax:
Practice Address - Street 1:1201 N STONEWALL AVE RM DCS253
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-6531
Practice Address - Fax:405-271-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty