Provider Demographics
NPI:1720685324
Name:ALTUS MANGUM DENTAL PLLC
Entity Type:Organization
Organization Name:ALTUS MANGUM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SETHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-782-5513
Mailing Address - Street 1:1410 N LOUIS TITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-2218
Mailing Address - Country:US
Mailing Address - Phone:580-782-5513
Mailing Address - Fax:580-782-5156
Practice Address - Street 1:1410 N LOUIS TITTLE AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-2218
Practice Address - Country:US
Practice Address - Phone:580-782-5513
Practice Address - Fax:580-782-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental