Healthcare Provider Details

I. General information

NPI: 1588769186
Provider Name (Legal Business Name): ANTHONY LIKES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 GRANDVIEW AVE
PAWHUSKA OK
74056-3201
US

IV. Provider business mailing address

715 GRANDVIEW AVE
PAWHUSKA OK
74056-3201
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-4491
  • Fax: 918-287-2347
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number3329
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: