MEDICARE: DR. CARL V DAIS D.D.S.

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	4905	OK

General Provider Information

NPI Number	:	1760539944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL V DAIS D.D.S.

Provider Business Mailing Address
First Line	:	8101 S WALKER AVE
Second Line	:	#D
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9418
Country	:	US
Telephone Number	:	405-631-0322
Fax Number	:	405-631-8620

Provider Business Practice Location Address
First Line	:	8101 S WALKER AVE
Second Line	:	#D
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9418
Country	:	US
Telephone Number	:	405-631-0322
Fax Number	:	405-631-8620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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