| Canadian Valley Dentistry Pllc | |
|
705 Eagle Circle El Reno OK 73036-2150 | |
| (405) 262-6677 | |
| (405) 262-1235 |
| Full Name | Canadian Valley Dentistry Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 705 Eagle Circle, El Reno, Oklahoma |
| Authorized Official Name and Position | Ray Dean Tate (DENTIST) |
| Authorized Official Contact | 4052626677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canadian Valley Dentistry Pllc 705 Eagle Circle El Reno OK 73036-2150 Ph: (405) 262-6677 | Canadian Valley Dentistry Pllc 705 Eagle Circle El Reno OK 73036-2150 Ph: (405) 262-6677 |
| NPI Number | 1720437296 |
|---|---|
| Provider Enumeration Date | 06/06/2016 |
| Last Update Date | 07/12/2021 |
| Medicare PECOS PAC ID | 2567865132 |
|---|---|
| Medicare Enrollment ID | O20210721000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720437296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | 6815 (Oklahoma) | Primary |
| Provider Name | Ray Dean Tate |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1558719245 PECOS PAC ID: 7416358437 Enrollment ID: I20210721000627 |
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