Provider Demographics
NPI:1619729704
Name:DENTAL PROFESSIONALS OF OKLAHOMA, PC
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF OKLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:138 SW 134TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1490
Mailing Address - Country:US
Mailing Address - Phone:405-378-5692
Mailing Address - Fax:405-759-2754
Practice Address - Street 1:138 SW 134TH ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-1490
Practice Address - Country:US
Practice Address - Phone:405-378-5692
Practice Address - Fax:405-759-2754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF OKLAHOMA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty