Healthcare Provider Details

I. General information

NPI: 1861532616
Provider Name (Legal Business Name): STEVEN EUGENE POWELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 24TH AVE SW
NORMAN OK
73069-5110
US

IV. Provider business mailing address

14809 CARLINGFORD WAY
EDMOND OK
73013-1846
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-8200
  • Fax: 405-307-8250
Mailing address:
  • Phone: 405-752-7072
  • Fax: 405-307-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4061
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: