Provider Demographics
NPI:1205519501
Name:OKLAHOMA CITY DENTISTRY PLLC
Entity type:Organization
Organization Name:OKLAHOMA CITY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDESSAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENBAJJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-676-5537
Mailing Address - Street 1:10001 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2730
Mailing Address - Country:US
Mailing Address - Phone:405-676-5537
Mailing Address - Fax:405-676-5924
Practice Address - Street 1:10001 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2730
Practice Address - Country:US
Practice Address - Phone:405-676-5537
Practice Address - Fax:405-676-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental