Healthcare Provider Details

I. General information

NPI: 1346722683
Provider Name (Legal Business Name): SPRING DENTAL BIXBY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 S MEMORIAL DR STE 103
BIXBY OK
74008-2570
US

IV. Provider business mailing address

400 RIVERWALK TER STE 250
JENKS OK
74037-5619
US

V. Phone/Fax

Practice location:
  • Phone: 918-998-0996
  • Fax:
Mailing address:
  • Phone: 191-898-8099
  • Fax: 918-310-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RENEE MCBAY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 918-998-0996