Provider Demographics
NPI:1679822175
Name:EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL
Entity Type:Organization
Organization Name:EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-452-3151
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-0236
Mailing Address - Country:US
Mailing Address - Phone:405-452-3151
Mailing Address - Fax:405-452-3310
Practice Address - Street 1:217 S 5TH ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-5222
Practice Address - Country:US
Practice Address - Phone:918-652-3676
Practice Address - Fax:918-652-7612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental