Provider Demographics
NPI:1932684297
Name:JEMIMA POITEVIEN, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:JEMIMA POITEVIEN, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEMIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:POITEVIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-923-8289
Mailing Address - Street 1:PO BOX 21224
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1224
Mailing Address - Country:US
Mailing Address - Phone:405-923-8289
Mailing Address - Fax:
Practice Address - Street 1:4225 W MEMORIAL RD STE 101-B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1761
Practice Address - Country:US
Practice Address - Phone:405-923-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEMIMA POITEVIEN, D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty