| Custom Dental Of Owasso, Pllc | |
|
11501 N. 135th East Ave Owasso OK 74055 | |
| (918) 371-7645 | |
| (918) 371-7272 |
| Full Name | Custom Dental Of Owasso, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 11501 N. 135th East Ave, Owasso, Oklahoma |
| Authorized Official Name and Position | Ron Campbell (DENTIST) |
| Authorized Official Contact | 9183717645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Dental Of Owasso, Pllc 2001 S Division St Guthrie OK 73044-6063 Ph: (405) 282-6440 | Custom Dental Of Owasso, Pllc 11501 N. 135th East Ave Owasso OK 74055 Ph: (918) 371-7645 |
| NPI Number | 1659689248 |
|---|---|
| Provider Enumeration Date | 09/17/2010 |
| Last Update Date | 09/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659689248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6099 (Oklahoma) | Primary |
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