Healthcare Provider Details

I. General information

NPI: 1356257513
Provider Name (Legal Business Name): CDA2026
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20926 SE 29TH ST STE A
HARRAH OK
73045-6610
US

IV. Provider business mailing address

1900 NW EXPWY ST STE 1600
OKLAHOMA CITY OK
73118-1839
US

V. Phone/Fax

Practice location:
  • Phone: 405-445-6999
  • Fax:
Mailing address:
  • Phone: 918-786-0017
  • 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: BRANDI A WILLIAMS
Title or Position: CHIEF GROWTH OFFICER
Credential:
Phone: 405-250-2255