Healthcare Provider Details

I. General information

NPI: 1912929324
Provider Name (Legal Business Name): TOM E DENTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

RR 2 BOX 247
STROUD OK
74079-9652
US

IV. Provider business mailing address

PO BOX 239
ARCADIA OK
73007-0239
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-9531
  • Fax:
Mailing address:
  • Phone: 405-396-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1289
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: