Healthcare Provider Details

I. General information

NPI: 1912731936
Provider Name (Legal Business Name): TECUMSEH FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N BROADWAY ST
TECUMSEH OK
74873-1414
US

IV. Provider business mailing address

400 RIVERWALK TER STE 250
JENKS OK
74037-5619
US

V. Phone/Fax

Practice location:
  • Phone: 405-598-9398
  • Fax: 405-598-0488
Mailing address:
  • Phone: 918-998-0996
  • Fax: 918-235-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CREED CARDON
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 918-998-0996