| Shattuck Dentistry & Braces | |
|
1523 S Main St Shattuck OK 73858-9223 | |
| (580) 938-2566 | |
| (580) 938-2567 |
| Full Name | Shattuck Dentistry & Braces |
|---|---|
| Speciality | Dentist |
| Location | 1523 S Main St, Shattuck, Oklahoma |
| Authorized Official Name and Position | Benjamin James Bowman (MANAGER) |
| Authorized Official Contact | 4053268004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shattuck Dentistry & Braces 1523 S. Main Shattuck OK 73858 Ph: (580) 938-2566 | Shattuck Dentistry & Braces 1523 S Main St Shattuck OK 73858-9223 Ph: (580) 938-2566 |
| NPI Number | 1114449394 |
|---|---|
| Provider Enumeration Date | 07/10/2017 |
| Last Update Date | 10/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114449394 | NPI | - | NPPES |
| 1205032935 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Kristen A Burris, D.d.s. L.l.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1515 South Main Street, Shattuck, OK 73858 Phone: 580-938-2566 Fax: 580-938-2567 |