Healthcare Provider Details

I. General information

NPI: 1043325061
Provider Name (Legal Business Name): DENTAL EXCELLENCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 4TH ST
SKIATOOK OK
74070
US

IV. Provider business mailing address

PO BOX 1090
SKIATOOK OK
74070
US

V. Phone/Fax

Practice location:
  • Phone: 918-396-3711
  • Fax: 918-396-1062
Mailing address:
  • Phone: 918-396-3711
  • Fax: 918-396-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4393
License Number StateOK

VIII. Authorized Official

Name: DR. BRADFORD RAY WILLIAMS
Title or Position: DENTIST OWNER
Credential:
Phone: 918-396-3711