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General NPI Number Information
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NPI Number | 1952698623
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL PROFESSIONALS OKLAHOMA OC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 1732 24TH AVE NW SUITE C-107
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City | NORMAN
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State | OK
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Zip | 73069-6397
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Country | US
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Telephone | 405-253-2043
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Fax | 405-579-2060
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Provider Business Mailing Address
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Address Line | 1732 24TH AVE NW SUITE C-107
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City | NORMAN
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State | OK
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Zip | 73069-6397
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Country | US
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Telephone | 405-253-2043
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Fax | 405-579-2060
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL PEEK
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Credential |
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Telephone | 405-253-2043
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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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