# DENTAL PROFESSIONALS OF OKLAHOMA, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DENTAL PROFESSIONALS OF OKLAHOMA, PC
- **Other names:** Little River Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649000605
- **Legal business name:** DENTAL PROFESSIONALS OF OKLAHOMA, PC
- **Authorized official:** CEMYIRA MCDOUGAL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 764-8609

## Contact information

- **Practice address:** 711 SW 19TH ST STE 100, MOORE, OK 73160-2966
- **Practice address phone:** (405) 913-7622
- **Mailing address:** 711 SW 19TH ST STE 100, MOORE, OK 73160-2966
- **Mailing address phone:** (405) 913-7622

## Taxonomy

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

## Other

- **Enumeration date:** 08/05/2024
- **Last updated:** 08/05/2024