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General NPI Number Information
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NPI Number | 1164834701
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES-MIDWEST CITY, P.C.
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 5301 MAIN STREET SUITE 111
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City | DEL CITY
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State | OK
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Zip | 73115
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Country | US
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Telephone | 405-672-0214
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Fax | 405-672-0226
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Provider Business Mailing Address
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Address Line | 5301 MAIN STREET SUITE 111
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City | DEL CITY
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State | OK
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Zip | 73115
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Country | US
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Telephone | 405-672-0214
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Fax | 405-672-0226
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD L. FENTEM JR.
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Credential | DDS
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Telephone | 405-672-0214
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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 | 4410
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License Number State | OK
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