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General NPI Number Information
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NPI Number | 1346762564
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Entity Type | Organization
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Legal Business Name | MUSTANG DENTISTRY & BRACES
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 1001 E. HIGHWAY 152 SUITE 113
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City | MUSTANG
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State | OK
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Zip | 73064
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Country | US
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Telephone | 405-353-1388
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 E HIGHWAY 152 SUITE 113
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City | MUSTANG
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State | OK
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Zip | 73064
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Country | US
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Telephone | 405-353-1388
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BENJAMIN JAMES BOWMAN
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Credential | DDS
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Telephone | 405-326-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6076
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License Number State | OK
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