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General NPI Number Information
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NPI Number | 1396458857
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Entity Type | Organization
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Legal Business Name | RONISHA DURHAM DDS PLLC
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Dates
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Enumeration Date | 12/29/2022
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 15260 LLEYTONS CT
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City | EDMOND
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State | OK
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Zip | 73013-7301
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Country | US
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Telephone | 405-492-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 N 23RD ST APT 2403
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City | BROKEN ARROW
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State | OK
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Zip | 74014-2171
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Country | US
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Telephone | 405-569-2604
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RONISHA DURHAM
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Credential | DDS
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Telephone | 405-569-2604
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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 |
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License Number State |
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