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General NPI Number Information
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NPI Number | 1629936331
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Entity Type | Organization
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Legal Business Name | COWETA DENTAL PLLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 29618 E STATE HIGHWAY 51
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City | COWETA
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State | OK
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Zip | 74429-7727
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Country | US
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Telephone | 918-486-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 851 W I 35 FRONTAGE RD STE 350
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City | EDMOND
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State | OK
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Zip | 73034-7472
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Country | US
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Telephone | 405-237-9289
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Fax | 405-669-8675
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Authorized Official
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Title or Position | PAYER RELATIONS ANALYST
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Name | KARA TAM-WALTS
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Credential |
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Telephone | 405-237-9289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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