Provider Demographics
NPI:1932730629
Name:BJP DENTAL, PLLC
Entity Type:Organization
Organization Name:BJP DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-342-5070
Mailing Address - Street 1:1480 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2405
Mailing Address - Country:US
Mailing Address - Phone:918-342-5070
Mailing Address - Fax:918-342-5073
Practice Address - Street 1:1480 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2405
Practice Address - Country:US
Practice Address - Phone:918-342-5070
Practice Address - Fax:918-342-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1568757532OtherNPI