MEDICARE: CLASSEN FAMILY DENTISTRY PC

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	261QD0000X	Dental Clinic/Center	4368	OK

General Provider Information

NPI Number	:	1437325388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLASSEN FAMILY DENTISTRY PC

Provider Business Mailing Address
First Line	:	3701 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2839
Country	:	US
Telephone Number	:	405-236-4755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2839
Country	:	US
Telephone Number	:	405-236-4755
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIM KIRBY
Credential	:	DDS
Telephone Number	:	405-236-4755

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	08/23/2011

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