Organization Name: | EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC. - HENRYETTA - DENTAL |
NPI Number: | 1679822175 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONNA DYER (CEO) |
Mailing Address: | 217 S 5th St Henryetta |
State: | OK US |
Postal Code: | 744375222 |
Phone Number: | 9186523676 |
Fax Number: | 9186527612 |
NPI Enumeration Date: | 08/30/2012 |
NPI Last Update Date: | 08/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |