Healthcare Provider Details

I. General information

NPI: 1821908559
Provider Name (Legal Business Name): DALLAS BLAKE DEMPSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 S 670 RD
GROVE OK
74344-6278
US

IV. Provider business mailing address

26730 S 670 RD
GROVE OK
74344-6278
US

V. Phone/Fax

Practice location:
  • Phone: 918-815-5944
  • Fax:
Mailing address:
  • Phone: 918-815-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberL083868478
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: