Healthcare Provider Details

I. General information

NPI: 1215016498
Provider Name (Legal Business Name): LEE A. ELIOT, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 ROBTRICE CT
EDMOND OK
73034-5714
US

IV. Provider business mailing address

924 ROBTRICE CT
EDMOND OK
73034-5714
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-5110
  • Fax: 405-340-5162
Mailing address:
  • Phone: 405-340-5110
  • Fax: 405-340-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4357
License Number StateOK

VIII. Authorized Official

Name: MRS. TRACY M WENTE
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 405-340-5110