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NPI Code Detail

MEDICARE: OKLAHOMA DENTAL-BROKEN ARROW

MEDICARE: OKLAHOMA DENTAL-BROKEN ARROW
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 : 1497815971
Entity Type Code : Organization
Provider Name (Legal Business Name) : OKLAHOMA DENTAL-BROKEN ARROW
Provider Business Mailing Address
First Line : 4801 RICHMOND SQ
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-2058
Country : US
Telephone Number : 405-840-5600
Fax Number : 405-842-9954
Provider Business Practice Location Address
First Line : 2234 W HOUSTON ST STE A
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3519
Country : US
Telephone Number : 918-251-0220
Fax Number : 405-842-9954
Authorized Official
Title or Position : INSURANCE COORDINATOR
Name : DIANE F CASTEEL
Credential :
Telephone Number : 405-840-5600
Provider Enumeration Date : 12/12/2006
Last Update Date : 08/22/2020

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Directions to “OKLAHOMA DENTAL-BROKEN ARROW ” 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.

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