| Shepherd Mall Family Dentistry | |
|
2401 Nw 23rd St Oklahoma City OK 73107-2442 | |
| (405) 942-0337 | |
| Not Available |
| Full Name | Shepherd Mall Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2401 Nw 23rd St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Mark Jay Allen (PARTNEER) |
| Authorized Official Contact | 4058446100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shepherd Mall Family Dentistry 519 S Santa Fe Ave Edmond OK 73003-6281 Ph: (405) 844-6100 | Shepherd Mall Family Dentistry 2401 Nw 23rd St Oklahoma City OK 73107-2442 Ph: (405) 942-0337 |
| NPI Number | 1013416940 |
|---|---|
| Provider Enumeration Date | 02/06/2018 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013416940 | NPI | - | NPPES |
| 4333 | Other | OK | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4333 (Oklahoma) | Primary |
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