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Organization
MICHAEL J. GLIDDON DBA LIVE OAK ORAL SURGERY
Active
Organization
MICHAEL J. GLIDDON DBA LIVE OAK ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERA ANN WELLNER (CREDENTIALING REP)
(405) 848-7974
Entity
Organization
Contact information
Practice address
1415 NW 33RD ST, LAWTON, OK 73505-3806
(580) 699-3131
(580) 699-3151
Mailing address
3000 UNITED FOUNDERS BLVD, SUITE 237, OKLAHOMA CITY, OK 73112-3958
(405) 848-7974
(405) 848-0033
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
160
OK
Other
Enumeration date
12/06/2010
Last updated
11/13/2013
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