Healthcare Provider Details

I. General information

NPI: 1932281268
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 NW 63RD ST SUITE 300
OKLAHOMA CITY OK
73116-1931
US

IV. Provider business mailing address

3727 NW 63RD ST SUITE 300
OKLAHOMA CITY OK
73116-1931
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-7994
  • Fax: 405-848-8020
Mailing address:
  • Phone: 405-848-7994
  • Fax: 405-848-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateOK

VIII. Authorized Official

Name: STEVE DODGE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 405-848-7994