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NPI Code Detail

MEDICARE: DR. DAVID LYNN BOONE D.D.S.

MEDICARE: DR. DAVID LYNN BOONE D.D.S.
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
11223G0001XGeneral Practice Dentistry3924OK

General Provider Information

NPI Number : 1073500864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID LYNN BOONE D.D.S.
Provider Business Mailing Address
First Line : 519 S 30TH ST
Second Line :
City : CLINTON
State : OK
Zip : 73601-3632
Country : US
Telephone Number : 580-323-1177
Fax Number :
Provider Business Practice Location Address
First Line : 519 S 30TH ST
Second Line :
City : CLINTON
State : OK
Zip : 73601-3632
Country : US
Telephone Number : 580-323-1177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 05/13/2014

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