Provider Demographics
NPI:1336818103
Name:OB HEARNE DDS PC
Entity Type:Organization
Organization Name:OB HEARNE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:HEARNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-579-7477
Mailing Address - Street 1:400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-2982
Mailing Address - Country:US
Mailing Address - Phone:580-584-3321
Mailing Address - Fax:580-584-3237
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-2982
Practice Address - Country:US
Practice Address - Phone:580-584-3321
Practice Address - Fax:580-584-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty