Provider Demographics
NPI:1861651903
Name:FAMILY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FOLKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-542-3337
Mailing Address - Street 1:1816 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-2748
Mailing Address - Country:US
Mailing Address - Phone:918-542-3337
Mailing Address - Fax:918-542-7218
Practice Address - Street 1:1816 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-2748
Practice Address - Country:US
Practice Address - Phone:918-542-3337
Practice Address - Fax:918-542-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty