Healthcare Provider Details

I. General information

NPI: 1063992121
Provider Name (Legal Business Name): EXCEL DENTISTRY AND BRACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 NW 23RD ST
OKLAHOMA CITY OK
73107-2212
US

IV. Provider business mailing address

2750 NW 23RD ST
OKLAHOMA CITY OK
73107-2212
US

V. Phone/Fax

Practice location:
  • Phone: 435-232-7801
  • Fax:
Mailing address:
  • Phone: 405-942-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7090
License Number StateOK

VIII. Authorized Official

Name: BRAD NELSON
Title or Position: OWNER
Credential:
Phone: 405-260-6080