| Custom Dental Of Edmond, Pllc | |
|
17840 N. Penn Oklahoma City OK 73012 | |
| (405) 282-6440 | |
| (405) 282-6785 |
| Full Name | Custom Dental Of Edmond, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 17840 N. Penn, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Grant Pitt (DENTIST) |
| Authorized Official Contact | 4052826440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Dental Of Edmond, Pllc 17840 N Pennsylvania Ave Edmond OK 73012-9097 Ph: (405) 282-6440 | Custom Dental Of Edmond, Pllc 17840 N. Penn Oklahoma City OK 73012 Ph: (405) 282-6440 |
| NPI Number | 1013211846 |
|---|---|
| Provider Enumeration Date | 01/10/2011 |
| Last Update Date | 09/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013211846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5978 (Oklahoma) | Primary |
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› Verified 9 days ago
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