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General NPI Number Information
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NPI Number | 1275773137
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Entity Type | Organization
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Legal Business Name | THE DENTAL LODGE
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 305-A MAIN STREET
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City | NOBLE
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State | OK
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Zip | 73068-0069
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Country | US
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Telephone | 405-872-9597
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Fax | 405-872-5271
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Provider Business Mailing Address
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Address Line | P.O. BOX 69
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City | NOBLE
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State | OK
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Zip | 73068-0069
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Country | US
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Telephone | 405-972-9597
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Fax | 405-872-5271
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GARY D NABORS JR.
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Credential |
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Telephone | 405-872-9597
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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 | OK
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