Healthcare Provider Details

I. General information

NPI: 1538354253
Provider Name (Legal Business Name): NORTH POINTE ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1021
US

IV. Provider business mailing address

13851 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1021
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-2083
  • Fax:
Mailing address:
  • Phone: 405-242-2083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5745
License Number StateOK

VIII. Authorized Official

Name: DR. BRYAN EVANS CARDON
Title or Position: PRESIDENT
Credential: DMD
Phone: 405-242-2083