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General NPI Number Information
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NPI Number | 1316297468
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Entity Type | Organization
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Legal Business Name | ERIC MASSAD DDS PLLC
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 2404 OLD SHAWNEE RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-1561
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Country | US
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Telephone | 918-684-3277
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Fax | 918-684-9606
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Provider Business Mailing Address
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Address Line | 2404 OLD SHAWNEE RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-1561
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Country | US
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Telephone | 918-684-3277
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Fax | 918-684-9606
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC R MASSAD
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Credential | D.D.S.
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Telephone | 918-684-3277
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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 | 5875
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License Number State | OK
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