Provider Demographics
NPI:1750166815
Name:DENTAL ARTS OF BIXBY, LLC
Entity type:Organization
Organization Name:DENTAL ARTS OF BIXBY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-593-9596
Mailing Address - Street 1:13000 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2523
Mailing Address - Country:US
Mailing Address - Phone:918-369-1202
Mailing Address - Fax:
Practice Address - Street 1:13000 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2523
Practice Address - Country:US
Practice Address - Phone:918-369-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental