=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417999731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEMIMA POITEVIEN D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 07/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W MAIN SUITE 200
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-6076
-----------------------------------------------------
Fax | 405-321-3830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W MAIN SUITE 200
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-6076
-----------------------------------------------------
Fax | 405-321-3830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5385
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------