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General NPI Number Information
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NPI Number | 1720590748
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, PLLC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 11476 S UNION AVE SUITE 102
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City | JENKS
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State | OK
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Zip | 74037
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Country | US
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Telephone | 918-417-6511
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Fax | 918-296-5290
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Provider Business Mailing Address
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Address Line | 200 N BROADWAY ST
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City | CHECOTAH
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State | OK
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Zip | 74426-2432
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Country | US
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Telephone | 918-864-1147
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Fax | 918-473-8100
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Authorized Official
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Title or Position | ENROLLMENT SPECIALIST
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Name | HALEY WOOSTER
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Credential |
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Telephone | 712-733-8551
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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 |
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License Number State |
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