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General NPI Number Information
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NPI Number | 1073135588
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Entity Type | Organization
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Legal Business Name | YUKON DENTISTRY & BRACES
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 901 E MAIN STREET SUITE 100
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 405-493-0830
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Fax |
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Provider Business Mailing Address
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Address Line | 901 E. MAIN ST STE 100
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 405-493-0830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN BOWMAN
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Credential |
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Telephone | 405-326-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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