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NPI Code Detail

MEDICARE: OKC DENTAL HEALTH ASSOCIATES, P.C.

MEDICARE: OKC DENTAL HEALTH ASSOCIATES, P.C.
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 Dentistry

General Provider Information

NPI Number : 1497175400
Entity Type Code : Organization
Provider Name (Legal Business Name) : OKC DENTAL HEALTH ASSOCIATES, P.C.
Provider Business Mailing Address
First Line : 6616 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6616 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1708
Country : US
Telephone Number : 405-601-7856
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : HANNAH FISH
Credential :
Telephone Number : 217-540-5699
Provider Enumeration Date : 04/17/2014
Last Update Date : 04/27/2016

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