MEDICARE: CHILDREN'S DENTAL CLINIC OF OKLAHOMA CITY AT PORTLAND PLAZA, 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	:	1235169129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S DENTAL CLINIC OF OKLAHOMA CITY AT PORTLAND PLAZA, PLLC

Provider Business Mailing Address
First Line	:	201 W 8TH ST
Second Line	:	SUITE 810
City	:	PUEBLO
State	:	CO
Zip	:	81003-3038
Country	:	US
Telephone Number	:	719-562-4447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6309
Country	:	US
Telephone Number	:	405-942-7755
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, LICENSING & CREDENTIALING
Name	:	MS. TRUDY WILLIAMS
Credential	:
Telephone Number	:	615-750-0342

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	05/17/2010

Similar Medicare Providers

1912897141 — DANIELLE C PACK RBT
Practice Location Address:

3635 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 704-519-8360
Practice Fax:

1710669338 — KASSADI EHL
Practice Location Address:

3635 NW 39TH EXPRESSWAY
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-857-8280
Practice Fax:

1578656393 — MARK T KELLY
Practice Location Address:

3637 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-942-7755
Practice Fax:

1285865337 — MAYES & MAYES OPTOMETRY, PLLC
Practice Location Address:

3631 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-943-2020
Practice Fax: 405-943-2021

1225260151 — DR. BRANDON ROBERT MAYES O.D.
Practice Location Address:

3631 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-943-2020
Practice Fax:

1336662790 — BRYCE MAYES OD
Practice Location Address:

3637 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-943-2020
Practice Fax:

Directions to “CHILDREN'S DENTAL CLINIC OF OKLAHOMA CITY AT PORTLAND PLAZA, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.