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General NPI Number Information
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NPI Number | 1750514329
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Entity Type | Individual
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Provider Name | NATHAN N. PROUD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 6002 S WESTERN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-1602
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Country | US
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Telephone | 405-631-9100
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Fax | 405-631-4672
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Provider Business Mailing Address
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Address Line | 555 W. BENJAMIN HOLT DR. BLDG. B
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City | STOCKTON
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State | CA
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Zip | 95207
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Country | US
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Telephone | 209-476-4700
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Fax | 209-478-6890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6152
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License Number State | OK
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