Healthcare Provider Details

I. General information

NPI: 1720909534
Provider Name (Legal Business Name): FIRST FLIGHT PEDIATRIC DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N BRYANT AVE
EDMOND OK
73034-3207
US

IV. Provider business mailing address

423 N BRYANT AVE
EDMOND OK
73034-3207
US

V. Phone/Fax

Practice location:
  • Phone: 405-265-6659
  • Fax: 405-265-6658
Mailing address:
  • Phone: 405-265-6659
  • Fax: 405-265-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A BOGRAN
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 918-289-3569