1467627356 NPI number — J ANDREW MCKAMIE DDS PC

Table of content: LEILANI RAQUEPO RAGASA M.D. (NPI 1073668166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467627356 NPI number — J ANDREW MCKAMIE DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J ANDREW MCKAMIE DDS 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:
CENTER FOR EXCEPTIONAL DENTISTRY
Provider Other Organization Name Type Code:
3
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:
1467627356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3645 N COUNCIL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHANY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73008-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-789-7893
Provider Business Mailing Address Fax Number:
405-789-8377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3645 N COUNCIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHANY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73008-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-789-7893
Provider Business Practice Location Address Fax Number:
405-789-8377
Provider Enumeration Date:
04/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCKAMIE
Authorized Official First Name:
J
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
DR./OWNER
Authorized Official Telephone Number:
405-789-7893

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4371 , 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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