Healthcare Provider Details

I. General information

NPI: 1053984930
Provider Name (Legal Business Name): NATALIE NICHOLE HAWORTH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10321 N 2274 RD
CLINTON OK
73601-7521
US

IV. Provider business mailing address

919 STONEGATE ST
WEATHERFORD OK
73096-5803
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-2884
  • Fax:
Mailing address:
  • Phone: 580-515-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4401
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: