Healthcare Provider Details

I. General information

NPI: 1285067033
Provider Name (Legal Business Name): JAMES MICHAEL WOMACK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13901 PARKWAY COMMONS DR STE D
OKLAHOMA CITY OK
73134-6225
US

IV. Provider business mailing address

13901 PARKWAY COMMONS DR STE D
OKLAHOMA CITY OK
73134-6225
US

V. Phone/Fax

Practice location:
  • Phone: 210-535-7848
  • Fax:
Mailing address:
  • Phone: 210-535-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61064
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number90
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number28885
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number28885
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number61064
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number41
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number28885
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number61064
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number00204675
License Number StateCO
# 10
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number00204675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: