Healthcare Provider Details

I. General information

NPI: 1508023383
Provider Name (Legal Business Name): THAI-AN DOAN D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11318 N MAY AVE SUITE B
OKLAHOMA CITY OK
73120-5860
US

IV. Provider business mailing address

11318 N MAY AVE SUITE B
OKLAHOMA CITY OK
73120-5860
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-5437
  • Fax: 405-748-6684
Mailing address:
  • Phone: 405-752-5437
  • Fax: 405-748-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5461
License Number StateOK

VIII. Authorized Official

Name: DR. THAI-AN DOAN
Title or Position: DENTIST
Credential: DDS
Phone: 405-752-5437