| Adventure Dental Of Midwest City | |
|
1200 S Air Depot Blvd Midwest City OK 73110-4866 | |
| (918) 872-7009 | |
| Not Available |
| Full Name | Adventure Dental Of Midwest City |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1200 S Air Depot Blvd, Midwest City, Oklahoma |
| Authorized Official Name and Position | Shaun Urbanozo (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7193232362 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventure Dental Of Midwest City 2221 E Bijou St Ste 100 Colorado Springs CO 80909-8009 Ph: (719) 576-1850 | Adventure Dental Of Midwest City 1200 S Air Depot Blvd Midwest City OK 73110-4866 Ph: (918) 872-7009 |
| NPI Number | 1912553215 |
|---|---|
| Provider Enumeration Date | 08/13/2019 |
| Last Update Date | 03/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912553215 | NPI | - | NPPES |
| 3942 | Other | OK | OK STATE DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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