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General NPI Number Information
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NPI Number | 1881704989
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Entity Type | Organization
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Legal Business Name | K GEORGE ELASSAL DDS INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11317 S WESTERN AVENUE SUITE 100 A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-5849
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Country | US
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Telephone | 405-692-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 11317 S WESTERN AVENUE SUITE 100 A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-5849
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Country | US
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Telephone | 405-692-2722
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. K GEORGE ELASSAL
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Credential | DDS
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Telephone | 405-692-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4541
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License Number State | OK
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