Provider Demographics
NPI:1952698623
Name:MODERN DENTAL PROFESSIONALS OKLAHOMA OC
Entity Type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS OKLAHOMA OC
Other - Org Name:MONARCH DENTAL - NORMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-253-2043
Mailing Address - Street 1:1732 24TH AVE NW
Mailing Address - Street 2:SUITE C-107
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6397
Mailing Address - Country:US
Mailing Address - Phone:405-253-2043
Mailing Address - Fax:405-579-2060
Practice Address - Street 1:1732 24TH AVE NW
Practice Address - Street 2:SUITE C-107
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6397
Practice Address - Country:US
Practice Address - Phone:405-253-2043
Practice Address - Fax:405-579-2060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN DENTAL PROFESSIONALS OKLAHOMA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty