Provider Demographics
NPI:1912780560
Name:ORAGEN LAWTON ORAL SURGERY PC
Entity Type:Organization
Organization Name:ORAGEN LAWTON ORAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-857-7947
Mailing Address - Street 1:3617 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3617 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6373
Practice Address - Country:US
Practice Address - Phone:405-691-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty