Healthcare Provider Details

I. General information

NPI: 1295660074
Provider Name (Legal Business Name): IOWA TRIBE OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 E HIGHWAY 33
PERKINS OK
74059-4129
US

IV. Provider business mailing address

509 E HIGHWAY 33
PERKINS OK
74059-4129
US

V. Phone/Fax

Practice location:
  • Phone: 405-547-2473
  • Fax: 405-547-2473
Mailing address:
  • Phone: 405-547-2473
  • Fax: 405-547-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA DAWN DAUGHERTY
Title or Position: DIRECTOR OF HEALTH
Credential:
Phone: 405-547-2473