| Henyretta Dental Center 2, Pllc | |
|
121 S 6th St Henryetta OK 74437-5009 | |
| (918) 652-2555 | |
| (918) 652-2556 |
| Full Name | Henyretta Dental Center 2, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 121 S 6th St, Henryetta, Oklahoma |
| Authorized Official Name and Position | Jeremy Scott Johnson (DENTIST) |
| Authorized Official Contact | 98186522555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Henyretta Dental Center 2, Pllc 121 S 6th St Henryetta OK 74437-5009 Ph: (918) 652-2555 | Henyretta Dental Center 2, Pllc 121 S 6th St Henryetta OK 74437-5009 Ph: (918) 652-2555 |
| NPI Number | 1750660700 |
|---|---|
| Provider Enumeration Date | 08/09/2011 |
| Last Update Date | 08/09/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750660700 | NPI | - | NPPES |
| 200085770A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5868 (Oklahoma) | Primary |
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