| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1419 N. Main, Jay, Oklahoma |
| Authorized Official Name and Position | Christy Youngblood (PRACTICE MANAGER) |
| Authorized Official Contact | 9182533331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 988 Jay OK 74346-0988 Ph: (918) 253-3331 | 1419 N. Main Jay OK 74346 Ph: (918) 253-3331 |
| NPI Number | 1720203102 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720203102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |