EDMOND PEDIATRIC AND TEEN DENTISTRY NPI 1235419409

NPI Information

EDMOND PEDIATRIC AND TEEN DENTISTRY is a pediatric dentistry dentist in Edmond, OK. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. EDMOND PEDIATRIC AND TEEN DENTISTRY NPI is 1235419409. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3824 S. BOULEVARD
SUITE 110
EDMOND, OK
ZIP 73013
Phone: (405) 513-8811

The provider's authorized official is Heath Austin Whitfield .
The authorized official title is Owner, President, Officer and has the following contact phone number (405) 513-8811.

The CLIA number assigned to this NPI record is 37D2141509 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 8/19/2011 and was last updated on 8/19/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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