Healthcare Provider Details

I. General information

NPI: 1720141609
Provider Name (Legal Business Name): OKLAHOMA DENTAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 NE 13TH ST
OKLAHOMA CITY OK
73104-2835
US

IV. Provider business mailing address

317 NE 13TH ST
OKLAHOMA CITY OK
73104-2835
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-8873
  • Fax: 405-848-8875
Mailing address:
  • Phone: 405-848-8873
  • Fax: 405-848-8875

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: DR. WILLIAM GOODMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 405-818-8873