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General NPI Number Information
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NPI Number | 1164604203
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, PLLC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 1875 N HIGHWAY 66 STE A
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City | CATOOSA
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State | OK
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Zip | 74015-3072
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Country | US
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Telephone | 918-266-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 1875 N HIGHWAY 66 STE A
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City | CATOOSA
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State | OK
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Zip | 74015-3072
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Country | US
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Telephone | 918-266-2906
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Fax |
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Authorized Official
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Title or Position | ENROLLMENT SPECIALIST
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Name | HALEY WOOSTER
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Credential |
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Telephone | 712-733-8551
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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 | 3749
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License Number State | OK
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