MEDICARE: ENDODONTIC ASSOCIATES 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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1952919052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	4500 MEMORIAL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5002
Country	:	US
Telephone Number	:	405-748-6000
Fax Number	:	405-749-5900

Provider Business Practice Location Address
First Line	:	4500 MEMORIAL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5002
Country	:	US
Telephone Number	:	405-748-6000
Fax Number	:	405-749-5900

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. CARA NELSON
Credential	:
Telephone Number	:	405-748-6000

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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