EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL - NPI NUMBER 1679822175

Summary

Provider Name: EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL

NPI Number: 1679822175

Clasification: Clinic/Center (261QD0000X)

Specialization: Dental

Address:
217 S 5TH ST
HENRYETTA, OK
ZIP 74437

Phone Number: (918) 652-3676



Detailed Information

EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL is a dental clinic/center in Henryetta, OK. The assigned NPI number for this provider is 1679822175 and is registered as an organization entity type.

The provider's business address is:

217 S 5TH ST
HENRYETTA, OK
ZIP 74437-222
Phone: (918) 652-3676
Fax: (918) 652-7612

The provider's authorized official is Donna Dyer .
The authorized official title is Ceo and has the following contact phone number (405) 452-3151.

The enumeration date for this NPI number is 8/30/2012 and was last updated on 8/30/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QD0000X Clinic/Center Dental Yes

NPI Record

No. Field Name Field Value
1 NPI 1679822175
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL
5 Provider First Line Business Practice Location Address 217 S 5TH ST
6 Provider Business Practice Location Address City Name HENRYETTA
7 Provider Business Practice Location Address State Name OK
8 Provider Business Practice Location Address Postal Code 744375222
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 9186523676
11 Provider Business Practice Location Address Fax Number 9186527612
12 Provider Enumeration Date 8/30/2012
13 Last Update Date 8/30/2012
14 Authorized Official Last Name DYER
15 Authorized Official First Name DONNA
16 Authorized Official Title or Position CEO
17 Authorized Official Telephone Number 4054523151
18 Healthcare Provider Taxonomy Code 1 261QD0000X
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart Y
21 Parent Organization LBN EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
22 Parent Organization TIN

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This page was last updated on: 7/15/2014
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