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	3749	OK

General Provider Information

NPI Number	:	1699791145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - OKLAHOMA, PLLC

Provider Business Mailing Address
First Line	:	200 N BROADWAY ST
Second Line	:
City	:	CHECOTAH
State	:	OK
Zip	:	74426-2432
Country	:	US
Telephone Number	:
Fax Number	:	918-473-0346

Provider Business Practice Location Address
First Line	:	1139 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-2006
Country	:	US
Telephone Number	:	918-259-0239
Fax Number	:	918-259-0265

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	11/06/2023

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