Provider Demographics
NPI:1710063136
Name:SILER, JOHNNY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:L
Last Name:SILER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 NW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8872
Mailing Address - Country:US
Mailing Address - Phone:405-306-3632
Mailing Address - Fax:
Practice Address - Street 1:1201 N STONEWALL AVE
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:405-271-8001
Practice Address - Fax:405-271-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice