Healthcare Provider Details

I. General information

NPI: 1609843291
Provider Name (Legal Business Name): CHRISTIAN HEATH PILGRIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SW 119TH ST
OKLAHOMA CITY OK
73170-6067
US

IV. Provider business mailing address

717 SW 119TH ST
OKLAHOMA CITY OK
73170-6067
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-0836
  • Fax: 405-691-0480
Mailing address:
  • Phone: 405-691-0836
  • Fax: 405-691-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5554
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: