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Organization
LIVE OAK ORAL SURGERY OF OKLAHOMA PLLC
Active
Organization
LIVE OAK ORAL SURGERY OF OKLAHOMA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J GLIDDON DDS (OWNER)
(580) 699-3131
Entity
Organization
Contact information
Practice address
5405 SW DAUN, LAWTON, OK 73505-8508
(580) 699-3131
(580) 699-3151
Mailing address
PO BOX 258841, OKLAHOMA CITY, OK 73125-8841
(580) 699-3131
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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