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General NPI Number Information
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NPI Number | 1154019925
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Entity Type | Organization
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Legal Business Name | DENTURES, IMPLANTS, AND DENTISTRY OF OKLAHOMA PLLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 1730 SHEDECK PARKWAY SUITES #100 AND #105
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 405-237-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 SHEDECK PKWY STE 100
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City | YUKON
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State | OK
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Zip | 73099-6010
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Country | US
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Telephone | 405-237-6453
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOHN FULLINGTON
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Credential | DDS
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Telephone | 405-237-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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