Provider Demographics
NPI:1770665069
Name:GUTHRIE DENTAL GROUP
Entity Type:Organization
Organization Name:GUTHRIE DENTAL GROUP
Other - Org Name:COMFORT DENTAL OF GUTHRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BROWN
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 1:2001 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6063
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:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK817971OtherCONCORDIA ID