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6301 Nw 23rd St Bethany OK 73008-5931 | |
| (405) 495-2402 | |
| (405) 495-1325 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6301 Nw 23rd St, Bethany, Oklahoma |
| Authorized Official Name and Position | Anusha Koneru (CEO) |
| Authorized Official Contact | 4054952402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6301 Nw 23rd St Bethany OK 73008-5931 Ph: (405) 495-2402 | 6301 Nw 23rd St Bethany OK 73008-5931 Ph: (405) 495-2402 |
| NPI Number | 1164979076 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 09/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164979076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6727 (Oklahoma) | Primary |
Olson Dental Group, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6801 Nw 39th Expy, Suite A, Bethany, OK 73008 Phone: 405-787-1946 | |