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General NPI Number Information
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NPI Number | 1912780560
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Entity Type | Organization
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Legal Business Name | ORAGEN LAWTON ORAL SURGERY PC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 3617 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-6373
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Country | US
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Telephone | 405-691-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 3617 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-6373
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR. OPERATIONS MANAGER
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Name | WHITNEY PAVICK
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Credential |
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Telephone | 801-857-7947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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