Healthcare Provider Details

I. General information

NPI: 1952919052
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL CIR
OKLAHOMA CITY OK
73142-5002
US

IV. Provider business mailing address

4500 MEMORIAL CIR
OKLAHOMA CITY OK
73142-5002
US

V. Phone/Fax

Practice location:
  • Phone: 405-748-6000
  • Fax: 405-749-5900
Mailing address:
  • Phone: 405-748-6000
  • Fax: 405-749-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARA NELSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-748-6000