Healthcare Provider Details

I. General information

NPI: 1083602239
Provider Name (Legal Business Name): SUE B ABER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S 4TH ST
MCALESTER OK
74501-5409
US

IV. Provider business mailing address

320 S 4TH ST
MCALESTER OK
74501-5409
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-0091
  • Fax: 918-423-0348
Mailing address:
  • Phone: 918-423-0091
  • Fax: 918-423-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberOK5268
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: