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General NPI Number Information
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NPI Number | 1750506606
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS OF PAWHUSKA, LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 1840 E MAIN ST
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City | PAWHUSKA
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State | OK
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Zip | 74056-2500
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Country | US
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Telephone | 918-287-4172
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Fax | 918-287-4176
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Provider Business Mailing Address
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Address Line | 1840 E MAIN ST
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City | PAWHUSKA
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State | OK
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Zip | 74056-2500
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Country | US
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Telephone | 918-287-4172
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Fax | 918-287-4176
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADAM BULLEIGH
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Credential | DDS
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Telephone | 918-287-4172
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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 | 5431
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License Number State | OK
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