Provider Demographics
NPI:1942642376
Name:JULIE SPEIGHTS,DDS,PLLC
Entity Type:Organization
Organization Name:JULIE SPEIGHTS,DDS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-360-2404
Mailing Address - Street 1:407 W COVELL RD UNIT 31795
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2331
Mailing Address - Country:US
Mailing Address - Phone:405-360-2404
Mailing Address - Fax:405-360-3414
Practice Address - Street 1:224 W GRAY ST STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7114
Practice Address - Country:US
Practice Address - Phone:405-360-2404
Practice Address - Fax:405-360-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054290AMedicaid