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General NPI Number Information
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NPI Number | 1518121342
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DENTAL SERVICES INC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 9822 NE 23RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73141
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Country | US
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Telephone | 405-769-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 9822 NE 23RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73141
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Country | US
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Telephone | 405-769-4445
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ROBERT L. PHILLIPS
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Credential | DDS
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Telephone | 405-769-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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