Provider Demographics
NPI:1932793106
Name:ALLIED DENTAL ASSOCIATES OF CHOCTAW PLLC
Entity Type:Organization
Organization Name:ALLIED DENTAL ASSOCIATES OF CHOCTAW PLLC
Other - Org Name:REST WELL SLEEP SOLUTIONS PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GASBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-390-2000
Mailing Address - Street 1:P.O. BOX 265
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020
Mailing Address - Country:US
Mailing Address - Phone:405-390-2000
Mailing Address - Fax:405-390-2018
Practice Address - Street 1:2401 N HENNEY RD
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8751
Practice Address - Country:US
Practice Address - Phone:405-390-2000
Practice Address - Fax:405-390-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies