Healthcare Provider Details

I. General information

NPI: 1689929184
Provider Name (Legal Business Name): RONALD FARAM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

1201 N STONEWALL AVE STE 286
OKLAHOMA CITY OK
73117-1214
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5714
  • Fax: 405-271-2405
Mailing address:
  • Phone: 405-271-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number6433
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number6433
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number6
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: