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NPI Code Detail

MEDICARE: CITY RESCUE MISSION DENTAL CLINIC

MEDICARE: CITY RESCUE MISSION DENTAL CLINIC
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
1122300000XDentist

General Provider Information

NPI Number : 1093936924
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY RESCUE MISSION DENTAL CLINIC
Provider Business Mailing Address
First Line : 800 W CALIFORNIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7807
Country : US
Telephone Number : 405-232-2709
Fax Number : 405-236-0341
Provider Business Practice Location Address
First Line : 800 W CALIFORNIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7807
Country : US
Telephone Number : 405-232-2709
Fax Number : 405-236-0341
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : DEBRA MCCULLOCK
Credential : ARNP
Telephone Number : 405-232-2709
Provider Enumeration Date : 05/01/2007
Last Update Date : 04/15/2009

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Directions to “CITY RESCUE MISSION DENTAL CLINIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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