1467591339 NPI number — ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OKLAHOMA PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467591339 NPI number — ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OKLAHOMA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OKLAHOMA PC
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:
1467591339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 108811
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73101-8811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-841-7686
Provider Business Mailing Address Fax Number:
405-848-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10900 HEFNER POINTE DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-5082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-463-0004
Provider Business Practice Location Address Fax Number:
405-463-0010
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
405-463-0004

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  3389 AND 4988 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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