Healthcare Provider Details

I. General information

NPI: 1457505927
Provider Name (Legal Business Name): GARY E. YOUREE D,D.S. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 2ND ST
HEAVENER OK
74937-3419
US

IV. Provider business mailing address

PO BOX 100
HEAVENER OK
74937-0100
US

V. Phone/Fax

Practice location:
  • Phone: 918-653-4808
  • Fax: 918-653-4772
Mailing address:
  • Phone: 918-653-4808
  • Fax: 918-653-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3621
License Number StateOK

VIII. Authorized Official

Name: DR. GARY EUGENE YOUREE
Title or Position: OWNER
Credential: D.D.S.
Phone: 918-653-4808