Provider Demographics
NPI:1740468305
Name:HEARTLAND DENTAL CARE OF OKLAHOMA, PC
Entity type:Organization
Organization Name:HEARTLAND DENTAL CARE OF OKLAHOMA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:735 E KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2029
Mailing Address - Country:US
Mailing Address - Phone:918-251-1521
Mailing Address - Fax:918-258-4226
Practice Address - Street 1:735 E KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2029
Practice Address - Country:US
Practice Address - Phone:918-251-1521
Practice Address - Fax:918-258-4226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF OKLAHOMA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty