Healthcare Provider Details

I. General information

NPI: 1619307865
Provider Name (Legal Business Name): NORTH POINTE ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2013
Last Update Date: 11/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1021
US

IV. Provider business mailing address

13851 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1021
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-2083
  • Fax: 405-242-2084
Mailing address:
  • Phone: 405-242-2083
  • Fax: 405-242-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52
License Number StateOK

VIII. Authorized Official

Name: DR. KIM WILKINSON
Title or Position: MANAGER
Credential: DDS
Phone: 405-242-2083