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NPI Code Detail

MEDICARE: KATHY L. DUNAVAN DEHART DDS PLLC

MEDICARE: KATHY L. DUNAVAN DEHART DDS 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
11223G0001XGeneral Practice Dentistry4924OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14924OTHEROKSTATE DENTAL BOARD

General Provider Information

NPI Number : 1508031337
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATHY L. DUNAVAN DEHART DDS PLLC
Provider Business Mailing Address
First Line : 13400 N PENNSYLVANIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-9007
Country : US
Telephone Number : 405-418-0888
Fax Number : 405-418-0891
Provider Business Practice Location Address
First Line : 13400 N PENNSYLVANIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-9007
Country : US
Telephone Number : 405-418-0888
Fax Number : 405-418-0891
Authorized Official
Title or Position : OWNER
Name : DR. KATHY LYNN DEHART
Credential : D.D.S.
Telephone Number : 405-418-0888
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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