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Organization
SHATTUCK DENTISTRY & BRACES
Active
Organization
SHATTUCK DENTISTRY & BRACES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN JAMES BOWMAN DDS (MANAGER)
(405) 326-8004
Entity
Organization
Contact information
Practice address
1523 S MAIN ST, SHATTUCK, OK 73858-9223
(580) 938-2566
(580) 938-2567
Mailing address
1523 S. MAIN, SHATTUCK, OK 73858
(580) 938-2566
(580) 938-2567
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205032935
—
OK
Enumeration date
07/10/2017
Last updated
10/29/2020
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