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General NPI Number Information
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NPI Number | 1225127889
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS GROUP
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 623 W BROADWAY AVE
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City | ENID
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State | OK
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Zip | 73701-3843
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Country | US
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Telephone | 580-234-4562
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Fax | 580-233-1190
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Provider Business Mailing Address
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Address Line | PO BOX 1308
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City | ENID
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State | OK
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Zip | 73702-1308
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Country | US
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Telephone | 580-234-4562
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Fax | 580-233-1190
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JAMES R MABRY
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Credential | D.D.S.
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Telephone | 580-234-4562
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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 | 3750
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License Number State | OK
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