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General NPI Number Information
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NPI Number | 1699883728
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Entity Type | Organization
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Legal Business Name | NORTHWEST OKLAHOMA DENTAL SERVICES
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 S MADISON
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City | ENID
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State | OK
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Zip | 73701-7210
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Country | US
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Telephone | 580-233-2333
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Fax | 580-233-5554
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Provider Business Mailing Address
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Address Line | 700 S MADISON
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City | ENID
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State | OK
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Zip | 73701-7210
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Country | US
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Telephone | 580-233-2333
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Fax | 580-233-5554
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BILL EDWARD TAYLOR
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Credential | DDS
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Telephone | 580-233-2333
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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 | 2911
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License Number State | OK
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