MEDICARE: DAVID MCALLISTER,D.M.D.,INC.

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	23401	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200077110A	OTHER	OK	SOONERCARE

General Provider Information

NPI Number	:	1851579163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID MCALLISTER,D.M.D.,INC.

Provider Business Mailing Address
First Line	:	3100 S ELM PL
Second Line	:	SUITE D
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7950
Country	:	US
Telephone Number	:	918-455-9444
Fax Number	:	918-451-3613

Provider Business Practice Location Address
First Line	:	3100 S ELM PL
Second Line	:	SUITE D
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7950
Country	:	US
Telephone Number	:	918-455-9444
Fax Number	:	918-451-3613

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DANA L SKINNER
Credential	:
Telephone Number	:	918-455-9444

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/11/2008

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Directions to “DAVID MCALLISTER,D.M.D.,INC. ” Practice Location

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