Healthcare Provider Details

I. General information

NPI: 1730590936
Provider Name (Legal Business Name): JOSEPH JANKOVICH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 RANDOLPH RD
FORT SILL OK
73503-4535
US

IV. Provider business mailing address

3525 NE 35TH ST
LAWTON OK
73507-1959
US

V. Phone/Fax

Practice location:
  • Phone: 580-442-2263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9361
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number61425
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: