MEDICARE: CALVIN DOAN DDS, 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	1223G0001X	General Practice Dentistry	5860	OK

General Provider Information

NPI Number	:	1568676484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVIN DOAN DDS, PC

Provider Business Mailing Address
First Line	:	PO BOX 60554
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0554
Country	:	US
Telephone Number	:	405-524-3356
Fax Number	:	405-524-4796

Provider Business Practice Location Address
First Line	:	1414 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2602
Country	:	US
Telephone Number	:	405-524-3356
Fax Number	:	405-524-4796

Authorized Official
Title or Position	:	DDS
Name	:	DR. KHOA ANH DOAN
Credential	:	DDS
Telephone Number	:	405-524-3356

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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