Provider Demographics
NPI:1750701603
Name:OKC DENTAL HEALTH ASSOCIATES, P.C.
Entity type:Organization
Organization Name:OKC DENTAL HEALTH ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:2401 12TH AVE NW STE 103
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 12TH AVE NW STE 103
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1471
Practice Address - Country:US
Practice Address - Phone:580-233-5962
Practice Address - Fax:580-223-5956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKC DENTAL HEALTH ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-18
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty