Provider Demographics
NPI:1821210444
Name:MICKEY SEHORN D.D.S., P.C.
Entity Type:Organization
Organization Name:MICKEY SEHORN D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-273-1020
Mailing Address - Street 1:1601 AIRPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804
Mailing Address - Country:US
Mailing Address - Phone:405-273-1020
Mailing Address - Fax:
Practice Address - Street 1:1601 AIRPORT DRIVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804
Practice Address - Country:US
Practice Address - Phone:405-273-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty