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General NPI Number Information
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NPI Number | 1356516017
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Entity Type | Organization
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Legal Business Name | NORMAN FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 709 W MAIN ST
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City | NORMAN
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State | OK
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Zip | 73069-6918
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Country | US
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Telephone | 405-321-6506
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Fax | 405-360-4570
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Provider Business Mailing Address
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Address Line | 709 W MAIN ST
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City | NORMAN
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State | OK
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Zip | 73069-6918
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Country | US
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Telephone | 405-321-6506
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Fax | 405-360-4570
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL ERNEST VENK
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Credential | D,D,S,
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Telephone | 405-321-6506
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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 | 4145
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License Number State | OK
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