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NPI Code Detail

MEDICARE: PRESTON KEITH PATRICK

MEDICARE:   PRESTON KEITH PATRICK
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
1122300000XDentist7853OK

General Provider Information

NPI Number : 1992550958
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRESTON KEITH PATRICK
Provider Business Mailing Address
First Line : 500 CENTRAL PARK DR APT 1214
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-1747
Country : US
Telephone Number : 918-822-2268
Fax Number :
Provider Business Practice Location Address
First Line : 6616 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1708
Country : US
Telephone Number : 405-601-7852
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2024
Last Update Date : 04/22/2024

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Directions to “ PRESTON KEITH PATRICK ” Practice Location

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