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General NPI Number Information
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NPI Number | 1720165616
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Entity Type | Organization
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Legal Business Name | ROY MADDOX DDS PC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 13000 SOUTH MEMORIAL DRIVE
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City | BIXBY
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State | OK
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Zip | 74008
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Country | US
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Telephone | 918-369-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 SOUTH MEMORIAL DRIVE
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City | BIXBY
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State | OK
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Zip | 74008
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Country | US
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Telephone | 918-369-1202
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ROY MADDOX
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Credential | DDS PC
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Telephone | 918-369-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4417
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License Number State | OK
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