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General NPI Number Information
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NPI Number | 1649914938
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Entity Type | Individual
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Provider Name | JAKE BOONE
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Gender | Male
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 7221 NW 23RD ST UNIT C-D
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City | BETHANY
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State | OK
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Zip | 73008-5131
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Country | US
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Telephone | 405-367-8147
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W KINGS RD
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City | ADA
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State | OK
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Zip | 74820-8219
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7560
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License Number State | OK
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