MEDICARE: NORTH POINTE ENDODONTICS 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	5745	OK

General Provider Information

NPI Number	:	1538354253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH POINTE ENDODONTICS PC

Provider Business Mailing Address
First Line	:	13851 QUAIL POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1021
Country	:	US
Telephone Number	:	405-242-2083
Fax Number	:

Provider Business Practice Location Address
First Line	:	13851 QUAIL POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1021
Country	:	US
Telephone Number	:	405-242-2083
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRYAN EVANS CARDON
Credential	:	DMD
Telephone Number	:	405-242-2083

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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