Healthcare Provider Details

I. General information

NPI: 1780601328
Provider Name (Legal Business Name): BRISTOW DENTAL DESIGNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N MAIN
BRISTOW OK
74010
US

IV. Provider business mailing address

PO BOX 867
BRISTOW OK
74010
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-3361
  • Fax: 918-367-7076
Mailing address:
  • Phone: 918-367-3361
  • Fax: 918-367-7076

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: DR. ROBERT H MELTON
Title or Position: DOCTOR
Credential: DDS
Phone: 918-367-3361