Healthcare Provider Details

I. General information

NPI: 1215939004
Provider Name (Legal Business Name): ORTHODONTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10914 HEFNER POINTE DR SUITE 300
OKLAHOMA CITY OK
73120-5066
US

IV. Provider business mailing address

10914 HEFNER POINTE DR SUITE 300
OKLAHOMA CITY OK
73120-5066
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-1526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4217
License Number StateOK

VIII. Authorized Official

Name: DAVID J BIRDWELL
Title or Position: DDS
Credential:
Phone: 405-947-1526