MEDICARE: DR. MICHAEL JAMES DUGAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3746	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	827171	OTHER	OK	UNITED CONCORDIA-UNICARE

General Provider Information

NPI Number	:	1063400927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAMES DUGAN DDS

Provider Business Mailing Address
First Line	:	4724 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5012
Country	:	US
Telephone Number	:	405-495-6190
Fax Number	:	405-495-0137

Provider Business Practice Location Address
First Line	:	4724 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5012
Country	:	US
Telephone Number	:	405-495-6190
Fax Number	:	405-495-0137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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