Provider Demographics
NPI:1689917643
Name:OKAN DENTAL, PLLC
Entity Type:Organization
Organization Name:OKAN DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-584-1800
Mailing Address - Street 1:202 E EXPRESSWAY 83
Mailing Address - Street 2:SUITE E
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6020
Mailing Address - Country:US
Mailing Address - Phone:956-584-1800
Mailing Address - Fax:956-584-1810
Practice Address - Street 1:202 E EXPRESSWAY 83
Practice Address - Street 2:SUITE E
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6020
Practice Address - Country:US
Practice Address - Phone:956-584-1800
Practice Address - Fax:956-584-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235128513OtherNPI INDIVIDUAL NUMBER
TX200561302Medicaid