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1670 Garth Brooks Blvd Suite 115 Yukon OK 73099-6878 | |
| (405) 494-3080 | |
| (405) 265-3555 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1670 Garth Brooks Blvd, Yukon, Oklahoma |
| Authorized Official Name and Position | Heather N. Pruemer (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1670 Garth Brooks Blvd Suite 115 Yukon OK 73099-6878 Ph: (405) 494-3080 | 1670 Garth Brooks Blvd Suite 115 Yukon OK 73099-6878 Ph: (405) 494-3080 |
| NPI Number | 1548557002 |
|---|---|
| Provider Enumeration Date | 07/06/2011 |
| Last Update Date | 09/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548557002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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