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General NPI Number Information
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NPI Number | 1487019071
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Entity Type | Organization
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Legal Business Name | STONEWOOD HILLS ORAL MAXILLOFACIAL SURGERY, INC.
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 425 STONE WOOD DR
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1026
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Country | US
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Telephone | 918-229-0292
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Fax |
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Provider Business Mailing Address
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Address Line | 425 STONE WOOD DR
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1026
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Country | US
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Telephone | 918-229-0292
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DESIREE W PINSON
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Credential |
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Telephone | 918-229-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5601
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License Number State | OK
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