1942642376 NPI number — JULIE SPEIGHTS,DDS,PLLC

Table of content: (NPI 1942642376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942642376 NPI number — JULIE SPEIGHTS,DDS,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE SPEIGHTS,DDS,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:
1942642376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 W COVELL RD UNIT 31795
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:
73003-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-360-2404
Provider Business Mailing Address Fax Number:
405-360-3414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 W GRAY ST STE 105
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:
73069-7114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-360-2404
Provider Business Practice Location Address Fax Number:
405-360-3414
Provider Enumeration Date:
07/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SPEIGHTS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-360-2404

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5293 , 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)

  • Identifier: 200054290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com