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General NPI Number Information
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NPI Number | 1184492977
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Entity Type | Organization
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Legal Business Name | 240 DG PLLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 7200 S PENNSYLVANIA AVE STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-3336
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Country | US
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Telephone | 405-681-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 S PENNSYLVANIA AVE STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-3336
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Country | US
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Telephone | 405-681-6668
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JOSHUA BRASHER
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Credential | DDS
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Telephone | 405-250-2255
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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 |
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License Number State |
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