Healthcare Provider Details

I. General information

NPI: 1770383374
Provider Name (Legal Business Name): DARE M OGANLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 W OKMULGEE ST
MUSKOGEE OK
74401-6839
US

IV. Provider business mailing address

814 W OKMULGEE ST
MUSKOGEE OK
74401-6839
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-9292
  • Fax: 918-682-0054
Mailing address:
  • Phone: 918-682-9292
  • Fax: 918-682-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberTEMP
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: