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General NPI Number Information
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NPI Number | 1841572591
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Entity Type | Organization
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Legal Business Name | MCALESTER CHILDREN'S DENTAL CLINIC
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 329 W CARL ALBERT PKWY
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City | MCALESTER
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State | OK
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Zip | 74501-4418
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Country | US
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Telephone | 918-423-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 329 W CARL ALBERT PKWY
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City | MCALESTER
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State | OK
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Zip | 74501-4418
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Country | US
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Telephone | 918-423-2897
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Fax | 918-423-0905
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANNA CHERYL MCINTOSH
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Credential | DDS
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Telephone | 918-423-2897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5023
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License Number State | OK
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