Provider Demographics
NPI:1730319211
Name:CUSTOM DENTAL OF ATOKA PLLC
Entity type:Organization
Organization Name:CUSTOM DENTAL OF ATOKA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOOKOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-282-6440
Mailing Address - Street 1:2001 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-6063
Mailing Address - Country:US
Mailing Address - Phone:405-282-6440
Mailing Address - Fax:405-282-6785
Practice Address - Street 1:1306 W. LIBERTY ROAD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-6063
Practice Address - Country:US
Practice Address - Phone:405-282-6440
Practice Address - Fax:405-282-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK61051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty