# OK OMS SPECIALTY DENTAL SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OK OMS SPECIALTY DENTAL SERVICES, PLLC
- **Other names:** Edmond Pediatric and Teen Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437958196
- **Legal business name:** OK OMS SPECIALTY DENTAL SERVICES, PLLC
- **Authorized official:** CHARLOTTE V DASCH (DIRECTOR OF CRED AND PROV REL)
- **Authorized official phone:** (615) 678-0759

## Contact information

- **Practice address:** 101 S SAINTS BLVD STE 212, EDMOND, OK 73034-3083
- **Practice address phone:** (405) 513-8811
- **Mailing address:** 1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
- **Mailing address phone:** (615) 678-0759

## 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:** 03/13/2025
- **Last updated:** 03/13/2025