MEDICARE: OKC DENTAL HEALTH ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1013337955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKC DENTAL HEALTH ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	14221 N PENNSYLVANIA AVE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-6096
Country	:	US
Telephone Number	:	405-775-0033
Fax Number	:	405-775-0044

Provider Business Practice Location Address
First Line	:	14221 N PENNSYLVANIA AVE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-6096
Country	:	US
Telephone Number	:	405-775-0033
Fax Number	:	405-775-0044

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	HANNAH FISH
Credential	:
Telephone Number	:	217-540-5699

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/27/2016

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