Healthcare Provider Details

I. General information

NPI: 1801800107
Provider Name (Legal Business Name): ORR FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S PARK DR
BROKEN BOW OK
74728-5722
US

IV. Provider business mailing address

1509 S PARK DR
BROKEN BOW OK
74728-5722
US

V. Phone/Fax

Practice location:
  • Phone: 580-584-3403
  • Fax:
Mailing address:
  • Phone: 580-584-3403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5140
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5122
License Number StateOK

VIII. Authorized Official

Name: DR. CHAD E ORR
Title or Position: CO-OWNER
Credential: D.D.S.
Phone: 580-584-3403