Shattuck Dentistry & Braces | |
1523 S Main St Shattuck OK 73858-9223 | |
(580) 938-2566 | |
(580) 938-2567 |
Full Name | Shattuck Dentistry & Braces |
---|---|
Speciality | Dentist |
Location | 1523 S Main St, Shattuck, Oklahoma |
Authorized Official Name and Position | Benjamin James Bowman (MANAGER) |
Authorized Official Contact | 4053268004 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Shattuck Dentistry & Braces 1523 S. Main Shattuck OK 73858 Ph: (580) 938-2566 | Shattuck Dentistry & Braces 1523 S Main St Shattuck OK 73858-9223 Ph: (580) 938-2566 |
NPI Number | 1114449394 |
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Provider Enumeration Date | 07/10/2017 |
Last Update Date | 10/29/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114449394 | NPI | - | NPPES |
1205032935 | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |
Kristen A Burris, D.d.s. L.l.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1515 South Main Street, Shattuck, OK 73858 Phone: 580-938-2566 Fax: 580-938-2567 |