Provider Demographics
NPI:1720590748
Name:AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, PLLC
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, PLLC
Other - Org Name:DDS DENTURES AND DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-733-8551
Mailing Address - Street 1:200 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-2432
Mailing Address - Country:US
Mailing Address - Phone:918-864-1147
Mailing Address - Fax:918-473-8100
Practice Address - Street 1:11476 S UNION AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037
Practice Address - Country:US
Practice Address - Phone:918-417-6511
Practice Address - Fax:918-296-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty