| Heritage Dental Group Llc | |
|
3600 W Tecumseh Rd Norman OK 73072 | |
| (405) 310-3111 | |
| Not Available |
| Full Name | Heritage Dental Group Llc |
|---|---|
| Speciality | Dentist |
| Location | 3600 W Tecumseh Rd, Norman, Oklahoma |
| Authorized Official Name and Position | Elie E. Abou-nassar (OWNER) |
| Authorized Official Contact | 4053103111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Dental Group Llc 3600 W Tecumseh Rd Norman OK 73072-1840 Ph: (405) 701-3111 | Heritage Dental Group Llc 3600 W Tecumseh Rd Norman OK 73072 Ph: (405) 310-3111 |
| NPI Number | 1881139319 |
|---|---|
| Provider Enumeration Date | 12/19/2016 |
| Last Update Date | 03/13/2024 |
| Medicare PECOS PAC ID | 9931571692 |
|---|---|
| Medicare Enrollment ID | O20230207002365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881139319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6017 (Oklahoma) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Elie E Abou Nassar |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366603987 PECOS PAC ID: 7911299177 Enrollment ID: I20230201003074 |
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