# MAIN STREET DENTAL, PLLC

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

## Provider details

- **NPI number:** 1679072664
- **Authorized official:** DR. DAVID HENRY DDS (OWNER)
- **Authorized official phone:** (918) 479-8020

## Contact information

- **Practice address:** 409 E MAIN ST, LOCUST GROVE, OK 74352-5116
- **Practice address phone:** (918) 845-5505
- **Mailing address:** 1707 FOREST HILL DR, CLAREMORE, OK 74017
- **Mailing address phone:** (918) 845-5505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 6531 | OK | Yes |

## Other

- **Enumeration date:** 02/06/2018
- **Last updated:** 03/02/2018