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General NPI Number Information
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NPI Number | 1174790505
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Entity Type | Organization
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Legal Business Name | MARY K. CASEY, DDS, PC
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 1111 N LEE AVE SUITE 331
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2600
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Country | US
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Telephone | 405-236-2094
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 N LEE AVE SUITE 331
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2600
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Country | US
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Telephone | 405-236-2094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY K. CASEY
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Credential | DDS
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Telephone | 405-231-8796
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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 | 4749
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License Number State | OK
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