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General NPI Number Information
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NPI Number | 1861930430
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Entity Type | Organization
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Legal Business Name | FORD DENTAL LAB INC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 2828 NW 57TH ST 307
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-6814
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Country | US
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Telephone | 405-887-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 NW 57TH ST STE 307
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112
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Country | US
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Telephone | 405-795-3169
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. VICTOR LEON STOLBACH
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Credential |
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Telephone | 405-887-0502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | DL65
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License Number State | OK
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