Provider Demographics
NPI:1760539936
Name:CROSSROADS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CROSSROADS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-631-0322
Mailing Address - Street 1:8101 S WALKER AVE
Mailing Address - Street 2:#D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9418
Mailing Address - Country:US
Mailing Address - Phone:405-631-0322
Mailing Address - Fax:405-631-8620
Practice Address - Street 1:8101 S WALKER AVE
Practice Address - Street 2:#D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9418
Practice Address - Country:US
Practice Address - Phone:405-631-0322
Practice Address - Fax:405-631-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty