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General NPI Number Information
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NPI Number | 1922578384
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Entity Type | Organization
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Legal Business Name | CHICKASHA DENTAL GROUP PLLC
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 823 W CHICKASHA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2307
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Country | US
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Telephone | 405-224-1727
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 E COVELL RD
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City | EDMOND
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State | OK
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Zip | 73034-6909
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Country | US
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Telephone | 405-224-1727
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | BRANDI ANN WILLIAMS
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Credential |
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Telephone | 405-250-2255
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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 |
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License Number State |
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