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NPI Code Detail

MEDICARE: RED OAK DENTAL

MEDICARE: RED OAK DENTAL
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
1122300000XDentist18729TX

General Provider Information

NPI Number : 1649678897
Entity Type Code : Organization
Provider Name (Legal Business Name) : RED OAK DENTAL
Provider Business Mailing Address
First Line : 269 E OVILLA RD STE 300
Second Line :
City : RED OAK
State : TX
Zip : 75154-2616
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 269 E OVILLA RD STE 300
Second Line :
City : RED OAK
State : TX
Zip : 75154-2616
Country : US
Telephone Number : 972-576-0248
Fax Number :
Authorized Official
Title or Position : PARTIAL OWNER
Name : ELBERT H STOKES
Credential : DDS
Telephone Number : 972-576-0248
Provider Enumeration Date : 12/19/2014
Last Update Date : 12/19/2014

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Directions to “RED OAK DENTAL ” Practice Location

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