# CANADIAN VALLEY DENTISTRY PLLC

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

## Provider details

- **NPI number:** 1720437296
- **Authorized official:** DR. RAY DEAN TATE D.D.S. (DENTIST)
- **Authorized official phone:** (405) 262-6677

## Contact information

- **Practice address:** 705 EAGLE CIRCLE, EL RENO, OK 73036-2150
- **Practice address phone:** (405) 262-6677
- **Practice address fax:** (405) 262-1235
- **Mailing address:** 705 EAGLE CIRCLE, EL RENO, OK 73036-2150
- **Mailing address phone:** (405) 262-6677
- **Mailing address fax:** (405) 262-1235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | 6815 | OK | Yes |

## Other

- **Enumeration date:** 06/06/2016
- **Last updated:** 07/12/2021