# ORAL SURGEONS OF OKLAHOMA LLC

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

## Provider details

- **NPI number:** 1518755578
- **Authorized official:** CASSIE WIETH (DIRECTOR OF PAYOR RELATIONS)
- **Authorized official phone:** (623) 267-8121

## Contact information

- **Practice address:** 1382 S DOUGLAS BLVD, MIDWEST CITY, OK 73130-5215
- **Practice address phone:** (405) 741-1962
- **Mailing address:** 1382 S DOUGLAS BLVD, MIDWEST CITY, OK 73130-5215
- **Mailing address phone:** (405) 741-1962

## 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:** 04/29/2025
- **Last updated:** 04/29/2025