# BAXTER SPRINGS FAMILY DENTISTRY PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1326621558
- **Authorized official:** MIKE YATES (COO)
- **Authorized official phone:** (918) 998-0996

## Contact information

- **Practice address:** 1440 PARK AVE, BAXTER SPRINGS, KS 66713-2727
- **Practice address phone:** (620) 856-2173
- **Mailing address:** 400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
- **Mailing address phone:** (918) 998-0996
- **Mailing address fax:** (918) 310-1056

## Taxonomy

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

## Other

- **Enumeration date:** 05/05/2021
- **Last updated:** 05/05/2021