| Eastern Oklahoma Oral And Maxillofacial Surgeons | |
|
4716 W Urbana St Broken Arrow OK 74012-5997 | |
| (918) 449-5800 | |
| (918) 455-8958 |
| Full Name | Eastern Oklahoma Oral And Maxillofacial Surgeons |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4716 W Urbana St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Angie Roe (CREDENTIALING AND CONTRACTING) |
| Authorized Official Contact | 8882471869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Oklahoma Oral And Maxillofacial Surgeons 4716 W Urbana St Broken Arrow OK 74012-5997 Ph: (918) 449-5800 | Eastern Oklahoma Oral And Maxillofacial Surgeons 4716 W Urbana St Broken Arrow OK 74012-5997 Ph: (918) 449-5800 |
| NPI Number | 1487074704 |
|---|---|
| Provider Enumeration Date | 04/25/2014 |
| Last Update Date | 03/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487074704 | NPI | - | NPPES |
| 200537790A | Medicaid | OK | |
| 200537790B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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