Custom Dental Of Yukon, PLLC
Clinic/Center, Dental in Yukon, OK. Organization (NPI-2).
NPI number1164049185
StatusActive
Last updated in NPPESJun 26, 2020
Details
- NPI
- 1164049185
- Entity type
- Organization (NPI-2)
- Legal business name
- Custom Dental Of Yukon, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 26, 2020
- Certification date
- Jun 26, 2020
- Last updated
- Jun 26, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
4425 Grant BlvdYukon, OK 73099
Phone 405-494-4856 · Fax 405-494-4184
Mailing address
4425 Grant BlvdYukon, OK 73099
Phone 405-494-4856 · Fax 405-494-4184
Authorized official
Katelyn Johnson
Owner-Doctor
9188399088
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All 8 Dental Clinic/Center providers in Yukon · All 1,518 providers in Yukon
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