Provider Demographics
NPI:1477727568
Name:C.BRANT WORTHINGTON DDD INC.
Entity type:Organization
Organization Name:C.BRANT WORTHINGTON DDD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:BRANT
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-737-0404
Mailing Address - Street 1:7901 NE 10TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3600
Mailing Address - Country:US
Mailing Address - Phone:405-737-0404
Mailing Address - Fax:405-737-0934
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-737-0404
Practice Address - Fax:405-737-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5-3257261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental