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General NPI Number Information
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NPI Number | 1447328349
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 1103 WALNUT DRIVE PEDIATRIC DENTAL ASSOCIATES PC
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-226-6290
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Fax | 580-223-4381
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Provider Business Mailing Address
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Address Line | 1103 WALNUT DRIVE PEDIATRIC DENTAL ASSOCIATES PC
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-226-6290
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Fax | 580-223-4381
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGENE A LITTEKEN
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Credential | DDS
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Telephone | 580-226-6290
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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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