Healthcare Provider Details

I. General information

NPI: 1700985181
Provider Name (Legal Business Name): JANICE L RALLS-HENRY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 NW GRAND BLVD
OKLAHOMA CITY OK
73118
US

IV. Provider business mailing address

1057 NW GRAND BLVD
OKLAHOMA CITY OK
73118
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-3400
  • Fax: 405-848-9741
Mailing address:
  • Phone: 405-840-3400
  • Fax: 405-848-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4950
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: