| Kenosha Breeze Family Dental Pllc | |
|
901 W Kenosha St Broken Arrow OK 74012-8918 | |
| (918) 258-8658 | |
| Not Available |
| Full Name | Kenosha Breeze Family Dental Pllc |
|---|---|
| Speciality | Dentist |
| Location | 901 W Kenosha St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Amanda Lightfoot (AUTHORIZED REPRESENTATIVE) |
| Authorized Official Contact | 2147020708 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenosha Breeze Family Dental Pllc 15660 Dallas Pkwy Ste 925 Dallas TX 75248-3323 Ph: (214) 702-0729 | Kenosha Breeze Family Dental Pllc 901 W Kenosha St Broken Arrow OK 74012-8918 Ph: (918) 258-8658 |
| NPI Number | 1346724044 |
|---|---|
| Provider Enumeration Date | 09/18/2018 |
| Last Update Date | 05/08/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346724044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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