MEDICARE: OPTIMUM DENTAL OF NEWCASTLE, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1578377610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM DENTAL OF NEWCASTLE, PLLC

Provider Business Mailing Address
First Line	:	550 NE 24TH ST STE G
Second Line	:
City	:	NEWCASTLE
State	:	OK
Zip	:	73065-6364
Country	:	US
Telephone Number	:	405-852-2200
Fax Number	:	405-852-2201

Provider Business Practice Location Address
First Line	:	550 NE 24TH ST STE G
Second Line	:
City	:	NEWCASTLE
State	:	OK
Zip	:	73065-6364
Country	:	US
Telephone Number	:	405-852-2200
Fax Number	:	405-852-2201

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MICHELLE WHITE
Credential	:
Telephone Number	:	405-206-2916

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	04/08/2026

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