Healthcare Provider Details

I. General information

NPI: 1245240779
Provider Name (Legal Business Name): MICHAEL PRESTON MCLEOD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 N MARTIN LUTHER KING AVE
OKLAHOMA CITY OK
73111-2404
US

IV. Provider business mailing address

2216 N MARTIN LUTHER KING AVE
OKLAHOMA CITY OK
73111-2404
US

V. Phone/Fax

Practice location:
  • Phone: 405-427-0237
  • Fax: 405-424-0115
Mailing address:
  • Phone: 405-427-0237
  • Fax: 405-424-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4310
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: