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Organization
EASTERN OKLAHOMA ORAL AND MAXILLOFACIAL SURGEONS
Active
Organization
EASTERN OKLAHOMA ORAL AND MAXILLOFACIAL SURGEONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGIE ROE (CREDENTIALING AND CONTRACTING)
(888) 247-1869
Entity
Organization
Contact information
Practice address
4716 W URBANA ST, BROKEN ARROW, OK 74012-5997
(918) 449-5800
(918) 455-8958
Mailing address
4716 W URBANA ST, BROKEN ARROW, OK 74012-5997
(918) 449-5800
(918) 455-8958
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
04/25/2014
Last updated
03/17/2018
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