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2522 E Kenosha St. Broken Arrow OK 74014-6712 | |
| (918) 355-1391 | |
| (918) 355-4135 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2522 E Kenosha St., Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Ron Fernandez (CEO) |
| Authorized Official Contact | 9189603070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5314 S Yale Ave. Suite 400 Tulsa OK 74135 Ph: (918) 960-3070 | 2522 E Kenosha St. Broken Arrow OK 74014-6712 Ph: (918) 355-1391 |
| NPI Number | 1265902183 |
|---|---|
| Provider Enumeration Date | 12/04/2018 |
| Last Update Date | 06/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265902183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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