Healthcare Provider Details

I. General information

NPI: 1457526824
Provider Name (Legal Business Name): HEFNER ROAD FAMILY DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 W HEFNER RD
OKLAHOMA CITY OK
73120-6318
US

IV. Provider business mailing address

2812 W HEFNER RD
OKLAHOMA CITY OK
73120-6318
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-0358
  • Fax: 405-755-4625
Mailing address:
  • Phone: 405-751-0358
  • Fax: 405-755-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4730
License Number StateOK

VIII. Authorized Official

Name: DR. PATRICK ARTHUR WOODS
Title or Position: MANAGER
Credential: DDS
Phone: 405-751-0358