# COMPLETE COSMETIC CARE DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053740563
- **Authorized official:** SANDY SALAMANDRA (OFFICE MANAGER)
- **Authorized official phone:** (918) 216-1000

## Contact information

- **Practice address:** 12136 S YUKON AVE, SAPULPA, OK 74066-6621
- **Practice address phone:** (918) 216-1000
- **Practice address fax:** (918) 216-1100
- **Mailing address:** 12136 S YUKON AVE, SAPULPA, OK 74066-6621
- **Mailing address phone:** (918) 216-1000
- **Mailing address fax:** (918) 216-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6032 | OK | Yes |

## Other

- **Enumeration date:** 11/05/2013
- **Last updated:** 11/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200201950A | — | OK |