Healthcare Provider Details

I. General information

NPI: 1609219849
Provider Name (Legal Business Name): DBSA OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD
OKLAHOMA CITY OK
73112-3958
US

IV. Provider business mailing address

3000 UNITED FOUNDERS BLVD
OKLAHOMA CITY OK
73112-3958
US

V. Phone/Fax

Practice location:
  • Phone: 405-413-7778
  • Fax:
Mailing address:
  • Phone: 405-413-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: GEORGE A CROOKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-413-7778