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General NPI Number Information
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NPI Number | 1932360765
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Entity Type | Organization
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Legal Business Name | DIXIELAND DENTAL, INC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 4117 NW 122ND ST SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8869
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Country | US
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Telephone | 405-751-4466
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Fax | 405-608-0163
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Provider Business Mailing Address
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Address Line | 4117 NW 122ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8869
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Country | US
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Telephone | 405-751-4466
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Fax | 405-608-0163
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATY SHAPARD
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Credential |
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Telephone | 405-751-4466
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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 | 5733
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License Number State | OK
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