Healthcare Provider Details

I. General information

NPI: 1669467270
Provider Name (Legal Business Name): PARLEY HUBLER JR DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 W CHICKASAW AVE
SALLISAW OK
74955-7200
US

IV. Provider business mailing address

1506 W CHICKASAW AVE
SALLISAW OK
74955-7200
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-3200
  • Fax: 918-775-0080
Mailing address:
  • Phone: 918-775-3200
  • Fax: 918-775-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5170
License Number StateOK

VIII. Authorized Official

Name: PARLEY MELVIN HUBLER JR.
Title or Position: PRESIDENT
Credential: DDS
Phone: 918-775-3200