Healthcare Provider Details

I. General information

NPI: 1790798411
Provider Name (Legal Business Name): DENTAL DESIGNS OF STROUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MAIN
STROUD OK
74079
US

IV. Provider business mailing address

PO BOX 684
STROUD OK
74079
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-1606
  • Fax: 918-968-1635
Mailing address:
  • Phone: 918-968-1606
  • Fax: 918-968-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3573
License Number StateOK

VIII. Authorized Official

Name: DR. ROBERT H MELTON
Title or Position: PRES
Credential: DDS
Phone: 918-968-1606