MEDICARE: PH DENTAL PLLC

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	122300000X	Dentist	6104	OK

General Provider Information

NPI Number	:	1225329659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PH DENTAL PLLC

Provider Business Mailing Address
First Line	:	2712 SW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-1806
Country	:	US
Telephone Number	:	405-212-4549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 SW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-1806
Country	:	US
Telephone Number	:	405-212-4549
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. YONG KI HONG
Credential	:	DDS
Telephone Number	:	405-409-4342

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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