Healthcare Provider Details

I. General information

NPI: 1811103229
Provider Name (Legal Business Name): BRYCE C. DORROUGH D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 S WALKER AVE
OKLAHOMA CITY OK
73139-9419
US

IV. Provider business mailing address

8301 S WALKER AVE
OKLAHOMA CITY OK
73139-9419
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-3525
  • Fax:
Mailing address:
  • Phone: 405-632-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4018
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: