Healthcare Provider Details

I. General information

NPI: 1104054170
Provider Name (Legal Business Name): KATIE LARUE WARLICK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 NW EXPRESSWAY STE 100
OKLAHOMA CITY OK
73132-5142
US

IV. Provider business mailing address

6401 NW EXPRESSWAY STE 100
OKLAHOMA CITY OK
73132-5142
US

V. Phone/Fax

Practice location:
  • Phone: 405-225-0776
  • Fax:
Mailing address:
  • Phone: 405-225-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6122
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: