MEDICARE: OKC DENTAL HEALTH ASSOCIATES, P.C.

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

General Provider Information

NPI Number	:	1942620885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKC DENTAL HEALTH ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1900 S AIR DEPOT BLVD
Second Line	:	SUITE 1
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-5522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 S AIR DEPOT BLVD
Second Line	:	SUITE 1
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-5522
Country	:	US
Telephone Number	:	405-455-1534
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	HANNAH FISH
Credential	:
Telephone Number	:	217-540-5699

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	06/13/2016

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