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General NPI Number Information
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NPI Number | 1386412328
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DENTAL ORAL HEALTH CENTER OF OKLAHOMA, P.C.
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 2619 S ELM PL
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7878
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Country | US
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Telephone | 918-872-0218
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Fax | 918-872-0892
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Provider Business Mailing Address
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Address Line | 63140 BRITTA ST STE D104
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City | BEND
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State | OR
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Zip | 97703-5738
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Country | US
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Telephone | 629-999-5014
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Fax |
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Authorized Official
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Title or Position | SR MANAGER
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Name | SHERRIE EDMONDSON
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Credential |
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Telephone | 629-999-5014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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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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