# LIVE OAK ORAL SURGERY OF OKLAHOMA PLLC

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

## Provider details

- **NPI number:** 1053986935
- **Authorized official:** MICHAEL J GLIDDON DDS (OWNER)
- **Authorized official phone:** (580) 699-3131

## Contact information

- **Practice address:** 5405 SW DAUN, LAWTON, OK 73505-8508
- **Practice address phone:** (580) 699-3131
- **Practice address fax:** (580) 699-3151
- **Mailing address:** PO BOX 258841, OKLAHOMA CITY, OK 73125-8841
- **Mailing address phone:** (580) 699-3131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2021
- **Last updated:** 05/24/2021