Healthcare Provider Details

I. General information

NPI: 1770472631
Provider Name (Legal Business Name): NICHOLAS MAKANA LONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 S DOUGLAS BLVD
MIDWEST CITY OK
73130-6225
US

IV. Provider business mailing address

1991 S DOUGLAS BLVD
MIDWEST CITY OK
73130-6225
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-6622
  • Fax: 405-733-2250
Mailing address:
  • Phone: 405-737-6622
  • Fax: 405-733-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8129
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: