Healthcare Provider Details

I. General information

NPI: 1487811725
Provider Name (Legal Business Name): JAMES R. YEARY P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WALL ST.
NORMAN OK
73069
US

IV. Provider business mailing address

801 WALL ST.
NORMAN OK
73069
US

V. Phone/Fax

Practice location:
  • Phone: 405-329-7171
  • Fax: 405-321-7540
Mailing address:
  • Phone: 405-329-7171
  • Fax: 405-321-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number4716
License Number StateOK

VIII. Authorized Official

Name: DR. JAMES R YEARY
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 405-329-7171