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Organization
SOUTHEAST OKLAHOMA ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization
SOUTHEAST OKLAHOMA ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
R. TODD BOONE DDS (ORAL SURGEON AND OWNER)
(580) 332-3010
Entity
Organization
Contact information
Practice address
803 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-3010
(580) 332-3010
Mailing address
803 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-3010
(580) 332-3010
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/25/2005
Last updated
05/06/2014
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