# BROKEN ARROW DENTAL AND IMPLANTS, LLC

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

## Provider details

- **NPI number:** 1568123438
- **Authorized official:** BRAD NELSON (OWNER)
- **Authorized official phone:** (405) 260-6080

## Contact information

- **Practice address:** 2109 W WASHINGTON ST, BROKEN ARROW, OK 74012-6801
- **Practice address phone:** (918) 455-0123
- **Mailing address:** 2109 W WASHINGTON ST, BROKEN ARROW, OK 74012-6801
- **Mailing address phone:** (918) 455-0123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/04/2022
- **Last updated:** 02/05/2024