| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 161 N 2nd Street, Fairfax, Oklahoma |
| Authorized Official Name and Position | Kelly Lynette Hadlock (OFFICE MANAGER) |
| Authorized Official Contact | 9186423400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
161 N 2nd Street Fairfax OK 74637 Ph: (918) 642-3400 | 161 N 2nd Street Fairfax OK 74637 Ph: (918) 642-3400 |
| NPI Number | 1588725485 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 02/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588725485 | NPI | - | NPPES |
| 100003750A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Fairfax Dental Office Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 158 N 2nd St, Fairfax, OK 74637 Phone: 918-642-3400 |