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General NPI Number Information
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NPI Number | 1689154569
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Entity Type | Organization
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Legal Business Name | ARROWHEAD DENTAL SERVICES, PLLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 1405 S DOUGLAS BLVD STE C
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City | MIDWEST CITY
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State | OK
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Zip | 73130-5240
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Country | US
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Telephone | 918-645-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 13381 PRESTWICK CIR
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City | CHOCTAW
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State | OK
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Zip | 73020-2037
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Country | US
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Telephone | 918-645-2540
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHASE C YOUNGBLOOD
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Credential | DDS
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Telephone | 918-645-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6052
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License Number State | OK
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