Healthcare Provider Details

I. General information

NPI: 1649690025
Provider Name (Legal Business Name): ANDREW MCGARRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 HEFNER POINTE DR STE 204
OKLAHOMA CITY OK
73120
US

IV. Provider business mailing address

10900 HEFNER POINTE DR STE 204
OKLAHOMA CITY OK
73120-5074
US

V. Phone/Fax

Practice location:
  • Phone: 405-463-0004
  • Fax:
Mailing address:
  • Phone: 405-463-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6594
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberG3-0000418
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: