Healthcare Provider Details

I. General information

NPI: 1154162832
Provider Name (Legal Business Name): AYRIKA EIDSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 N SANTA FE AVE
EDMOND OK
73003-4337
US

IV. Provider business mailing address

14729 ASHORE DR
OKLAHOMA CITY OK
73142-7861
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-6606
  • Fax:
Mailing address:
  • Phone: 405-517-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7871
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: