Provider Demographics
NPI:1457526824
Name:HEFNER ROAD FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:HEFNER ROAD FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-751-0358
Mailing Address - Street 1:2812 W HEFNER RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6318
Mailing Address - Country:US
Mailing Address - Phone:405-751-0358
Mailing Address - Fax:405-755-4625
Practice Address - Street 1:2812 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6318
Practice Address - Country:US
Practice Address - Phone:405-751-0358
Practice Address - Fax:405-755-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty