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100 Starlite Dr Kingfisher OK 73750 | |
| (405) 375-5855 | |
| (405) 358-2946 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 100 Starlite Dr, Kingfisher, Oklahoma |
| Authorized Official Name and Position | Benjamin James Bowman (OWNER) |
| Authorized Official Contact | 4053755855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9060 Harmony Dr Ste E Midwest City OK 73130 Ph: (405) 594-8844 | 100 Starlite Dr Kingfisher OK 73750 Ph: (405) 375-5855 |
| NPI Number | 1992849996 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 02/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992849996 | NPI | - | NPPES |
| 200208490A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3767 (Oklahoma) | Primary |
Kingfisher Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2302 Frontage Rd, Kingfisher, OK 73750 Phone: 405-375-5855 Fax: 405-375-5863 |