Healthcare Provider Details

I. General information

NPI: 1669449872
Provider Name (Legal Business Name): DR CHRISTIAN H PILGRIM DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SW 119TH ST
OKLAHOMA CITY OK
73170
US

IV. Provider business mailing address

717 SW 119TH ST
OKLAHOMA CITY OK
73170
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: DR. CHRISTIAN H PILGRIM
Title or Position: OWNER / DENTIST
Credential: DDS.
Phone: 405-691-0836