| Pawnee Dental Clinic | |
|
622 7th St Pawnee OK 74058-2541 | |
| (918) 762-3501 | |
| (918) 762-2600 |
| Full Name | Pawnee Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 622 7th St, Pawnee, Oklahoma |
| Authorized Official Name and Position | Gary Stark Henderson (DENTIST) |
| Authorized Official Contact | 9187623501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pawnee Dental Clinic 622 7th St Pawnee OK 74058-2541 Ph: (918) 762-3501 | Pawnee Dental Clinic 622 7th St Pawnee OK 74058-2541 Ph: (918) 762-3501 |
| NPI Number | 1548565070 |
|---|---|
| Provider Enumeration Date | 01/13/2011 |
| Last Update Date | 01/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548565070 | NPI | - | NPPES |
| 100053630A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 3796 (Oklahoma) | Primary |