MEDICARE: DR. PATTI JANE CLEVES 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	4817	OK

General Provider Information

NPI Number	:	1841232113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATTI JANE CLEVES D.D.S.

Provider Business Mailing Address
First Line	:	4514 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-6901
Country	:	US
Telephone Number	:	405-722-6028
Fax Number	:	405-720-2435

Provider Business Practice Location Address
First Line	:	4514 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-6901
Country	:	US
Telephone Number	:	405-722-6028
Fax Number	:	405-720-2435

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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