Healthcare Provider Details

I. General information

NPI: 1043959091
Provider Name (Legal Business Name): RADU ALEXANDRU JIFCU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 05/28/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31870 EAST HWY 51
COWETA OK
74429
US

IV. Provider business mailing address

31870 EAST HWY 51
COWETA OK
74429
US

V. Phone/Fax

Practice location:
  • Phone: 918-279-3431
  • Fax:
Mailing address:
  • Phone: 918-279-3431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number107470
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7927
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: