MEDICARE: RAMADAN DENTAL GROUP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598939738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMADAN DENTAL GROUP

Provider Business Mailing Address
First Line	:	3315 NW 63RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-607-4845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3791
Country	:	US
Telephone Number	:	405-607-4845
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SALAM RAMADAN
Credential	:	D.D.S.
Telephone Number	:	405-607-4845

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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