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General NPI Number Information
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NPI Number | 1699395343
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALISTS OF EDMOND
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 16430 MUIRFIELD PL
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-696-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 17705 SPARROW HAWK LN
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City | EDMOND
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State | OK
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Zip | 73012-7137
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Country | US
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Telephone | 405-510-6853
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. YACOUB AL SAKKA
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Credential | DDS
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Telephone | 405-696-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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