Eastern Oklahoma Oral And Maxillofacial Surgeons | |
4716 W Urbana St Broken Arrow OK 74012-5997 | |
(918) 449-5800 | |
(918) 455-8958 |
Full Name | Eastern Oklahoma Oral And Maxillofacial Surgeons |
---|---|
Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 4716 W Urbana St, Broken Arrow, Oklahoma |
Authorized Official Name and Position | Angie Roe (CREDENTIALING AND CONTRACTING) |
Authorized Official Contact | 8882471869 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Eastern Oklahoma Oral And Maxillofacial Surgeons 4716 W Urbana St Broken Arrow OK 74012-5997 Ph: (918) 449-5800 | Eastern Oklahoma Oral And Maxillofacial Surgeons 4716 W Urbana St Broken Arrow OK 74012-5997 Ph: (918) 449-5800 |
NPI Number | 1487074704 |
---|---|
Provider Enumeration Date | 04/25/2014 |
Last Update Date | 03/17/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487074704 | NPI | - | NPPES |
200537790A | Medicaid | OK | |
200537790B | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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