# NOVA ORAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeast Oklahoma Oral and Maxillofacial
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225747736
- **Authorized official:** HANS CHARLES IGOU DDS (OWNER)
- **Authorized official phone:** (580) 332-3010

## Contact information

- **Practice address:** 803 N MONTE VISTA ST, ADA, OK 74820-7711
- **Practice address phone:** (580) 332-3010
- **Practice address fax:** (580) 332-3010
- **Mailing address:** 803 N MONTE VISTA ST, ADA, OK 74820-7711
- **Mailing address phone:** (580) 332-3010
- **Mailing address fax:** (580) 332-1302

## 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:** 11/23/2022
- **Last updated:** 11/23/2022