Healthcare Provider Details

I. General information

NPI: 1194949586
Provider Name (Legal Business Name): EXCEL DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXCEL DENTAL 2750 N.W. 23 ST.
OKLAHOMA CITY OK
73107-2212
US

IV. Provider business mailing address

2750 NW 23RD ST
OKLAHOMA CITY OK
73107-2212
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-4445
  • Fax: 405-943-3949
Mailing address:
  • Phone: 405-942-4445
  • Fax: 405-943-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5176
License Number StateOK

VIII. Authorized Official

Name: DR. HA MINH NGUYEN
Title or Position: OWNER
Credential: DDS
Phone: 405-942-4445