Healthcare Provider Details

I. General information

NPI: 1861651903
Provider Name (Legal Business Name): FAMILY DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 N MAIN ST
MIAMI OK
74354-2748
US

IV. Provider business mailing address

1816 N MAIN ST
MIAMI OK
74354-2748
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-3337
  • Fax: 918-542-7218
Mailing address:
  • Phone: 918-542-3337
  • Fax: 918-542-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MARK FOLKS
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 918-542-3337