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General NPI Number Information
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NPI Number | 1134898216
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Entity Type | Individual
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Provider Name | AMIT BALASAHEB SOPE
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Gender | Male
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 611 S GEORGE NIGH EXPY
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City | MCALESTER
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State | OK
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Zip | 74501-7277
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Country | US
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Telephone | 918-715-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 828 HARDY SPRINGS CIR APT A
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City | MCALESTER
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State | OK
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Zip | 74501-7375
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Country | US
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Telephone | 682-307-9203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7503
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License Number State | OK
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