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General NPI Number Information
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NPI Number | 1083306716
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Entity Type | Organization
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Legal Business Name | REDBUD DENTAL EDMOND, PLLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 18001 N WESTERN AVE STE 106
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City | EDMOND
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State | OK
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Zip | 73012-9135
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Country | US
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Telephone | 405-447-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 400 RIVERWALK TER STE 250
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City | JENKS
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State | OK
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Zip | 74037-5619
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Country | US
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Telephone | 918-998-0996
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Fax | 918-235-9079
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Authorized Official
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Title or Position | OWNER
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Name | CREED CARDON
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Credential |
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Telephone | 918-998-0996
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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 |
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License Number State |
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