Healthcare Provider Details

I. General information

NPI: 1699777375
Provider Name (Legal Business Name): DAVID L SCHWARTZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11317 S WESTERN AVE SUITE 100B
OKLAHOMA CITY OK
73170-5849
US

IV. Provider business mailing address

11317 S WESTERN AVE SUITE 100B
OKLAHOMA CITY OK
73170-5849
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-0100
  • Fax: 405-691-7892
Mailing address:
  • Phone: 405-691-0100
  • Fax: 405-691-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9005
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: