Healthcare Provider Details

I. General information

NPI: 1669265864
Provider Name (Legal Business Name): FERRIS KALIDY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BOULEVARD STE 118
EDMOND OK
73034-3880
US

IV. Provider business mailing address

10400 HUNTERS POINTE
EDMOND OK
73034-1610
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-9182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8039
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8039
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: