MEDICARE: DR. CHRIS ALAN POORE DDS, MS

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	122300000X	Dentist	5878	OK

General Provider Information

NPI Number	:	1124178348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS ALAN POORE DDS, MS

Provider Business Mailing Address
First Line	:	9112 N. MAY AVE.
Second Line	:
City	:	OKLA. CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-947-0486
Fax Number	:	405-942-4392

Provider Business Practice Location Address
First Line	:	9112 N. MAY AVE.
Second Line	:
City	:	OKLA. CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-947-0486
Fax Number	:	405-942-4392

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/13/2015

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