Healthcare Provider Details

I. General information

NPI: 1144667643
Provider Name (Legal Business Name): JOSHUA KUYKENDALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 12TH AVE NW
ARDMORE OK
73401-1470
US

IV. Provider business mailing address

3450 N COMMERCE ST APT 206
ARDMORE OK
73401-1526
US

V. Phone/Fax

Practice location:
  • Phone: 580-798-0340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6496
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: