Provider Demographics
NPI:1639202468
Name:ALBERT C CAYWOOD DDS INC
Entity type:Organization
Organization Name:ALBERT C CAYWOOD DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-223-8789
Mailing Address - Street 1:1015 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1810
Mailing Address - Country:US
Mailing Address - Phone:580-223-8789
Mailing Address - Fax:580-490-9202
Practice Address - Street 1:1015 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1810
Practice Address - Country:US
Practice Address - Phone:580-223-8789
Practice Address - Fax:580-490-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty