Healthcare Provider Details

I. General information

NPI: 1356516017
Provider Name (Legal Business Name): NORMAN FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN ST
NORMAN OK
73069-6918
US

IV. Provider business mailing address

709 W MAIN ST
NORMAN OK
73069-6918
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-6506
  • Fax: 405-360-4570
Mailing address:
  • Phone: 405-321-6506
  • Fax: 405-360-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number4145
License Number StateOK

VIII. Authorized Official

Name: DR. RANDALL ERNEST VENK
Title or Position: PRESIDENT
Credential: D,D,S,
Phone: 405-321-6506