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General NPI Number Information
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NPI Number | 1780601328
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Entity Type | Organization
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Legal Business Name | BRISTOW DENTAL DESIGNS
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 N MAIN
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City | BRISTOW
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State | OK
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Zip | 74010
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Country | US
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Telephone | 918-367-3361
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Fax | 918-367-7076
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Provider Business Mailing Address
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Address Line | PO BOX 867
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City | BRISTOW
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State | OK
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Zip | 74010
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Country | US
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Telephone | 918-367-3361
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Fax | 918-367-7076
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT H MELTON
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Credential | DDS
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Telephone | 918-367-3361
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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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