1346865425 NPI number — HWY 9 DENTAL STUDIO PLLC

Table of content: (NPI 1346865425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346865425 NPI number — HWY 9 DENTAL STUDIO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HWY 9 DENTAL STUDIO PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346865425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 E COVELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73034-6909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-359-0808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3391 CLASSEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73071-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-321-2414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRASHER
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
405-474-6362

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)