MEDICARE: NORTH POINTE ENDODONTICS, 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	1223E0200X	Endodontics	52	OK

General Provider Information

NPI Number	:	1619307865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH POINTE ENDODONTICS, PLLC

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	:	405-242-2084

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	:	405-242-2084

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KIM WILKINSON
Credential	:	DDS
Telephone Number	:	405-242-2083

Provider Enumeration Date	:	11/24/2013
Last Update Date	:	11/24/2013

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