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General NPI Number Information
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NPI Number | 1750688248
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Entity Type | Organization
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Legal Business Name | CARRIE DS FAMILY DENTISTRY INC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 400 RIVERWALK TERRACE SUITE 200
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City | JENKS
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State | OK
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Zip | 74037-5627
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Country | US
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Telephone | 918-392-7654
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Fax | 918-518-5760
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Provider Business Mailing Address
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Address Line | 400 RIVERWALK TERRACE SUITE 200
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City | JENKS
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State | OK
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Zip | 74037-5627
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Country | US
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Telephone | 918-392-7654
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Fax | 918-518-5760
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARRIE D SESSOM
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Credential | D.D.S.
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Telephone | 918-392-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5239
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License Number State | OK
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