Provider Demographics
NPI:1982024840
Name:OKC DENTAL HEALTH ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:OKC DENTAL HEALTH ASSOCIATES, P.C.
Other - Org Name:LAKE TEXOMA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:9072 W HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-6513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9072 W HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-6513
Practice Address - Country:US
Practice Address - Phone:580-931-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKC DENTAL HEALTH ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty