# SHATTUCK DENTISTRY & BRACES

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

## Provider details

- **NPI number:** 1114449394
- **Authorized official:** DR. BENJAMIN JAMES BOWMAN DDS (MANAGER)
- **Authorized official phone:** (405) 326-8004

## Contact information

- **Practice address:** 1523 S MAIN ST, SHATTUCK, OK 73858-9223
- **Practice address phone:** (580) 938-2566
- **Practice address fax:** (580) 938-2567
- **Mailing address:** 1523 S. MAIN, SHATTUCK, OK 73858
- **Mailing address phone:** (580) 938-2566
- **Mailing address fax:** (580) 938-2567

## Taxonomy

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

## Other

- **Enumeration date:** 07/10/2017
- **Last updated:** 10/29/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1205032935 | — | OK |