Provider Demographics
NPI:1841788866
Name:YUKON KIDS DENTAL
Entity Type:Organization
Organization Name:YUKON KIDS DENTAL
Other - Org Name:YUKON KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:405-578-5234
Mailing Address - Street 1:1600 GARTH BROOKS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7412
Mailing Address - Country:US
Mailing Address - Phone:405-578-5234
Mailing Address - Fax:
Practice Address - Street 1:1600 GARTH BROOKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7412
Practice Address - Country:US
Practice Address - Phone:405-578-5234
Practice Address - Fax:405-578-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty