Healthcare Provider Details

I. General information

NPI: 1053349514
Provider Name (Legal Business Name): STEVEN D PRACHT D.D.S, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SW 7TH ST
LINDSAY OK
73052-5212
US

IV. Provider business mailing address

102 SW 7TH ST
LINDSAY OK
73052-5212
US

V. Phone/Fax

Practice location:
  • Phone: 405-756-4093
  • Fax: 405-756-4093
Mailing address:
  • Phone: 405-756-4093
  • Fax: 405-756-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4130
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: