# CUSTOM DENTAL OF OWASSO, PLLC

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

## Provider details

- **NPI number:** 1659689248
- **Authorized official:** DR. RON CAMPBELL DDS (DENTIST)
- **Authorized official phone:** (918) 371-7645

## Contact information

- **Practice address:** 11501 N. 135TH EAST AVE, OWASSO, OK 74055
- **Practice address phone:** (918) 371-7645
- **Practice address fax:** (918) 371-7272
- **Mailing address:** 2001 S DIVISION ST, GUTHRIE, OK 73044-6063
- **Mailing address phone:** (405) 282-6440
- **Mailing address fax:** (405) 282-6785

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6099 | OK | Yes |

## Other

- **Enumeration date:** 09/17/2010
- **Last updated:** 09/17/2010