Healthcare Provider Details

I. General information

NPI: 1366603987
Provider Name (Legal Business Name): ELIE ABOU NASSAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W TECUMSEH RD
NORMAN OK
73072-1840
US

IV. Provider business mailing address

3600 W TECUMSEH RD
NORMAN OK
73072-1840
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-3111
  • Fax: 405-701-2524
Mailing address:
  • Phone: 405-701-3111
  • Fax: 405-701-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6017
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6017
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: