# DENTAL SPECIALISTS OF EDMOND

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

## Provider details

- **NPI number:** 1699395343
- **Authorized official:** DR. YACOUB AL SAKKA DDS (CO-OWNER)
- **Authorized official phone:** (405) 696-0908

## Contact information

- **Practice address:** 16430 MUIRFIELD PL, EDMOND, OK 73013
- **Practice address phone:** (405) 696-0908
- **Mailing address:** 17705 SPARROW HAWK LN, EDMOND, OK 73012-7137
- **Mailing address phone:** (405) 510-6853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | NULL | Yes |
| 1223P0700X | Prosthodontics | — | — | Yes |

## Other

- **Enumeration date:** 04/23/2020
- **Last updated:** 04/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1497023196 | PROVIDER 02 | OK |
| 01 | — | 1568862357 | PROVIDER 01 | OK |