Healthcare Provider Details

I. General information

NPI: 1417038589
Provider Name (Legal Business Name): LINDSAY FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SW 7TH ST.
LINDSAY OK
73052
US

IV. Provider business mailing address

102 SW 7TH ST.
LINDSAY OK
73052
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: DR. STEVEN D PRACHT
Title or Position: PRESIDENT
Credential:
Phone: 405-756-4093