Healthcare Provider Details

I. General information

NPI: 1417974429
Provider Name (Legal Business Name): PHILIP JUSTIN POWER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N KELLY AVE
EDMOND OK
73003-3005
US

IV. Provider business mailing address

3000 N KELLY AVE
EDMOND OK
73003-3005
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-2233
  • Fax:
Mailing address:
  • Phone: 405-562-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5658
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: