| Eagle Dental Corp Inc | |
|
6520 East Reno Midwest City OK 73110-2109 | |
| (405) 732-6821 | |
| (405) 732-7970 |
| Full Name | Eagle Dental Corp Inc |
|---|---|
| Speciality | Dentist |
| Location | 6520 East Reno, Midwest City, Oklahoma |
| Authorized Official Name and Position | Mary E Martin (CEO VICE PRESIDENT) |
| Authorized Official Contact | 4057326821 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Dental Corp Inc 6520 East Reno Midwest City OK 73110-2109 Ph: (405) 732-6821 | Eagle Dental Corp Inc 6520 East Reno Midwest City OK 73110-2109 Ph: (405) 732-6821 |
| NPI Number | 1235141029 |
|---|---|
| Provider Enumeration Date | 08/12/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235141029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4609 (Oklahoma) | Secondary |
| 122300000X | Dentist | 4594 (Oklahoma) | Primary |
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