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General NPI Number Information
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NPI Number | 1316432040
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTISTRY
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 700 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6777
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Country | US
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Telephone | 405-494-7227
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Fax |
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Provider Business Mailing Address
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Address Line | 700 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6777
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAY D TATE
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Credential | DDS
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Telephone | 405-420-4270
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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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