Provider Demographics
NPI:1932281268
Name:ORAL AND MAXILLOFACIAL ASSOCIATES
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-848-7994
Mailing Address - Street 1:3727 NW 63RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1931
Mailing Address - Country:US
Mailing Address - Phone:405-848-7994
Mailing Address - Fax:405-848-8020
Practice Address - Street 1:3727 NW 63RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1931
Practice Address - Country:US
Practice Address - Phone:405-848-7994
Practice Address - Fax:405-848-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty