MEDICARE: AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, 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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1538462932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, PLLC

Provider Business Mailing Address
First Line	:	7336 S OLYMPIA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1849
Country	:	US
Telephone Number	:	918-446-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7336 S OLYMPIA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1849
Country	:	US
Telephone Number	:	918-446-2700
Fax Number	:

Authorized Official
Title or Position	:	ENROLLMENT SPECIALIST
Name	:	HALEY WOOSTER
Credential	:
Telephone Number	:	712-733-8551

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	09/20/2021

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