Provider Demographics
NPI:1881704989
Name:K GEORGE ELASSAL DDS INC
Entity type:Organization
Organization Name:K GEORGE ELASSAL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:K
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ELASSAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-692-2722
Mailing Address - Street 1:11317 S WESTERN AVENUE
Mailing Address - Street 2:SUITE 100 A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5849
Mailing Address - Country:US
Mailing Address - Phone:405-692-2722
Mailing Address - Fax:
Practice Address - Street 1:11317 S WESTERN AVENUE
Practice Address - Street 2:SUITE 100 A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5849
Practice Address - Country:US
Practice Address - Phone:405-692-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
332664771001OtherBCBS
677423OtherUNITED CONCORDIA