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Organization
VIBRANT LIFE DIRECT CARE, PLLC
Active
Organization
VIBRANT LIFE DIRECT CARE, PLLC
Active
Other names
Vibrant Life Direct Care, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYDIA J. DENNIS DO (OWNER)
(405) 708-3385
Entity
Organization
Contact information
Practice address
501 N MUSTANG RD STE B, MUSTANG, OK 73064-7044
(405) 708-3385
(800) 488-3294
Mailing address
5225 E TYLER DR, TUTTLE, OK 73089-8305
(405) 708-3385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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