| Michael J. Gliddon Dba Live Oak Oral Surgery | |
|
1415 Nw 33rd St Lawton OK 73505-3806 | |
| (580) 699-3131 | |
| (580) 699-3151 |
| Full Name | Michael J. Gliddon Dba Live Oak Oral Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1415 Nw 33rd St, Lawton, Oklahoma |
| Authorized Official Name and Position | Vera Ann Wellner (CREDENTIALING REP) |
| Authorized Official Contact | 4058487974 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael J. Gliddon Dba Live Oak Oral Surgery 3000 United Founders Blvd Suite 237 Oklahoma City OK 73112-3958 Ph: (405) 848-7974 | Michael J. Gliddon Dba Live Oak Oral Surgery 1415 Nw 33rd St Lawton OK 73505-3806 Ph: (580) 699-3131 |
| NPI Number | 1265735724 |
|---|---|
| Provider Enumeration Date | 12/06/2010 |
| Last Update Date | 11/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265735724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 160 (Oklahoma) | Primary |
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