| Organization Name: | HENYRETTA DENTAL CENTER 2, PLLC |
| NPI Number: | 1750660700 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEREMY SCOTT JOHNSON (DENTIST) |
| Mailing Address: | 121 S 6th St Henryetta |
| State: | OK US |
| Postal Code: | 744375009 |
| Phone Number: | 9186522555 |
| Fax Number: | 9186522556 |
| NPI Enumeration Date: | 08/09/2011 |
| NPI Last Update Date: | 08/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 5868 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |