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General NPI Number Information
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NPI Number | 1083871768
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Entity Type | Organization
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Legal Business Name | ALLIED DENTAL ASSOCIATES OF CHOCTAW PLLC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 2401 N HENNEY RD
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City | CHOCTAW
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State | OK
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Zip | 73020-8751
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Country | US
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Telephone | 405-390-2000
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Fax | 405-390-2018
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Provider Business Mailing Address
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Address Line | 2401 N HENNY RD
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City | CHOCTAW
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State | OK
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Zip | 73020-0265
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Country | US
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Telephone | 405-390-2000
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Fax | 405-390-2018
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | TRACY ANN GASBARRA
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Credential | D.D.S
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Telephone | 405-390-2000
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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 | 5671
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License Number State | OK
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