Provider Demographics
NPI:1629254776
Name:THE DENTISTS AT LANGLEY
Entity Type:Organization
Organization Name:THE DENTISTS AT LANGLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,INC,PC
Authorized Official - Phone:918-782-2009
Mailing Address - Street 1:P.O. BOX 189
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74350
Mailing Address - Country:US
Mailing Address - Phone:918-782-2009
Mailing Address - Fax:918-782-1042
Practice Address - Street 1:1666 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:OK
Practice Address - Zip Code:74350
Practice Address - Country:US
Practice Address - Phone:918-782-2009
Practice Address - Fax:918-782-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200057320AMedicaid