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Organization
OKC PROSTH PLLC
Active
Organization
OKC PROSTH PLLC
Active
Other names
Southwest OKC Oklahoma Implants and Dentures
Organization subpart
No
Provider details
NPI number
Authorized official
SARA BROWN (CREDENTIALING MANAGER)
(918) 998-0996
Entity
Organization
Contact information
Practice address
11317 S WESTERN AVE STE 500, OKLAHOMA CITY, OK 73170-5851
(918) 998-0996
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
(918) 310-1056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
07/20/2021
Last updated
10/07/2021
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