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General NPI Number Information
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NPI Number | 1821322660
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Entity Type | Organization
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Legal Business Name | HAPPY TOOTH DENTAL GROUP OF SKIATOOK P.C.
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 5265 W ROGERS BLVD STE C
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City | SKIATOOK
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State | OK
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Zip | 74070-5200
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Country | US
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Telephone | 918-396-7766
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Fax | 918-396-7767
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Provider Business Mailing Address
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Address Line | 5265 W ROGERS BLVD STE C
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City | SKIATOOK
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State | OK
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Zip | 74070-5200
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Country | US
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Telephone | 918-396-7766
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Fax | 918-396-7767
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONAH R.B. VANDIVER
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Credential | D.D.S.
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Telephone | 918-396-7766
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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 | 5392
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License Number State | OK
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