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General NPI Number Information
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NPI Number | 1073712949
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Entity Type | Organization
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Legal Business Name | CATOOSA DENTAL CARE, PLC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1755 N HIGHWAY 66 SUITE # D
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City | CATOOSA
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State | OK
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Zip | 74015-2409
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Country | US
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Telephone | 918-266-3866
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Fax | 918-266-3880
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Provider Business Mailing Address
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Address Line | PO BOX 1227
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City | CATOOSA
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State | OK
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Zip | 74015-1227
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Country | US
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Telephone | 918-266-3866
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Fax | 918-266-3880
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL LEON BREWER
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Credential | D.D.S
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Telephone | 918-266-3866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5182
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License Number State | OK
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