MEDICARE: NOWLIN DENTAL CLINIC

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	4652	OK

General Provider Information

NPI Number	:	1750323135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOWLIN DENTAL CLINIC

Provider Business Mailing Address
First Line	:	201 GARRETT ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4332
Country	:	US
Telephone Number	:	580-225-4690
Fax Number	:	580-225-8205

Provider Business Practice Location Address
First Line	:	201 GARRETT ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4332
Country	:	US
Telephone Number	:	580-225-4690
Fax Number	:	580-225-8205

Authorized Official
Title or Position	:	PARTNER
Name	:	LISA A. NOWLIN
Credential	:
Telephone Number	:	580-225-4690

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/22/2020

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Directions to “NOWLIN DENTAL CLINIC ” Practice Location

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