Healthcare Provider Details

I. General information

NPI: 1750498788
Provider Name (Legal Business Name): GARY DEAN BINTZ D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 E HARTFORD AVE
PONCA CITY OK
74601-2016
US

IV. Provider business mailing address

1402 REVEILLE DR
PONCA CITY OK
74604-4438
US

V. Phone/Fax

Practice location:
  • Phone: 580-765-3055
  • Fax: 580-765-3410
Mailing address:
  • Phone: 580-762-4341
  • Fax: 580-767-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9356
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: