MEDICARE: WARR ACRES DENTAL GROUP PLLC

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

General Provider Information

NPI Number	:	1073146452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARR ACRES DENTAL GROUP PLLC

Provider Business Mailing Address
First Line	:	5813 NW 50TH ST
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5113
Country	:	US
Telephone Number	:	405-474-6362
Fax Number	:

Provider Business Practice Location Address
First Line	:	5813 NW 50TH ST
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5113
Country	:	US
Telephone Number	:	405-474-6362
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JOSHUA BRASHER
Credential	:	DDS
Telephone Number	:	405-474-6362

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/13/2020

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