Healthcare Provider Details

I. General information

NPI: 1588609192
Provider Name (Legal Business Name): STEVEN MICHAEL FICK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11609 S WESTERN AVE
OKLAHOMA CITY OK
73170-5823
US

IV. Provider business mailing address

11609 S WESTERN AVE
OKLAHOMA CITY OK
73170-5823
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-7388
  • Fax: 405-692-7699
Mailing address:
  • Phone: 405-692-7388
  • Fax: 405-692-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5109
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: