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General NPI Number Information
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NPI Number | 1245782499
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Entity Type | Organization
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Legal Business Name | WINDMILL DENTISTRY PLLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 2313 E OKMULGEE ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5924
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Country | US
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Telephone | 918-910-5227
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 E. OKMULGEE ST
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City | MUSKOGEE
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State | OK
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Zip | 74403
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Country | US
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Telephone | 918-910-5227
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MAX DWAYNE BIRD
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Credential | D.D.S.
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Telephone | 918-910-5227
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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 | 3833
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License Number State | OK
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