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717 S I 35 Service Rd Ste C Moore OK 73160-3190 | |
| (405) 378-4774 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 717 S I 35 Service Rd Ste C, Moore, Oklahoma |
| Authorized Official Name and Position | Priscilla Pickens-larson (OWNER/ ORTHODONTIST) |
| Authorized Official Contact | 4053784774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
717 S I 35 Service Rd Ste C Moore OK 73160-3190 Ph: (405) 378-4774 | 717 S I 35 Service Rd Ste C Moore OK 73160-3190 Ph: (405) 378-4774 |
| NPI Number | 1104206887 |
|---|---|
| Provider Enumeration Date | 06/08/2015 |
| Last Update Date | 06/08/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104206887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 189 (Oklahoma) | Primary |
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