Organization Name: | SPIRO FAMILY DENTAL P.C. |
NPI Number: | 1730277740 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEIFER LAYNE FISHER (PRESIDENT) |
Mailing Address: | 318 W Broadway St Spiro |
State: | OK US |
Postal Code: | 749592422 |
Phone Number: | 9189622466 |
Fax Number: | 9189624004 |
NPI Enumeration Date: | 10/11/2006 |
NPI Last Update Date: | 01/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 4826 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |