Provider Demographics
NPI:1780601328
Name:BRISTOW DENTAL DESIGNS
Entity type:Organization
Organization Name:BRISTOW DENTAL DESIGNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-367-3361
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010
Mailing Address - Country:US
Mailing Address - Phone:918-367-3361
Mailing Address - Fax:918-367-7076
Practice Address - Street 1:121 N MAIN
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010
Practice Address - Country:US
Practice Address - Phone:918-367-3361
Practice Address - Fax:918-367-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty