| Mydentist-broken Arrow | |
|
3451 W Kenosha St Broken Arrow OK 74012-8949 | |
| (918) 307-0909 | |
| Not Available |
| Full Name | Mydentist-broken Arrow |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3451 W Kenosha St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Hannah Fish (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175405699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mydentist-broken Arrow 3451 W Kenosha St Broken Arrow OK 74012-8949 Ph: () - | Mydentist-broken Arrow 3451 W Kenosha St Broken Arrow OK 74012-8949 Ph: (918) 307-0909 |
| NPI Number | 1457771032 |
|---|---|
| Provider Enumeration Date | 04/22/2014 |
| Last Update Date | 04/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457771032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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