Healthcare Provider Details

I. General information

NPI: 1649104837
Provider Name (Legal Business Name): SERENITY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 KELLY LAKES PASS
EDMOND OK
73025-9271
US

IV. Provider business mailing address

825 KELLY LAKES PASS
EDMOND OK
73025-9271
US

V. Phone/Fax

Practice location:
  • Phone: 405-861-8601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIGAIL POULAN
Title or Position: DENTIST
Credential: DDS
Phone: 405-308-9447