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General NPI Number Information
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NPI Number | 1558655761
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Entity Type | Organization
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Legal Business Name | REGION DENTAL
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 148 W MAIN ST SUITE D
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City | GLENPOOL
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State | OK
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Zip | 74033-3951
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Country | US
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Telephone | 918-321-2000
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Fax | 918-321-2766
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Provider Business Mailing Address
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Address Line | 148 W MAIN ST SUITE D
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City | GLENPOOL
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State | OK
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Zip | 74033-3951
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Country | US
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Telephone | 918-321-2000
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Fax | 918-321-2766
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. RYAN KERMIT NOAH
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Credential | DDS
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Telephone | 918-607-7277
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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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