Healthcare Provider Details

I. General information

NPI: 1770685182
Provider Name (Legal Business Name): WILLIAM EDWARD HOLCOMB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 N PORTLAND #209
OKLA CITY OK
73112
US

IV. Provider business mailing address

6303 N PORTLAND #209
OKLA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-7771
  • Fax: 405-942-7796
Mailing address:
  • Phone: 405-942-7771
  • Fax: 405-942-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4788
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: