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General NPI Number Information
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NPI Number | 1083415475
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Entity Type | Organization
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Legal Business Name | BISON DENTAL PC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 2700 CACTUS DR
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City | GUYMON
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State | OK
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Zip | 73942-6003
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Country | US
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Telephone | 580-262-8900
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Fax | 949-607-4267
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Provider Business Mailing Address
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Address Line | 85 ARGONAUT STE 220
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4105
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Country | US
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Telephone | 949-403-7044
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CARYL L HOLLINGER
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Credential |
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Telephone | 949-403-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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