# BROKEN BOW DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Broken Bow Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811658685
- **Authorized official:** KEITH BARTLETT DDS (MANAGER)
- **Authorized official phone:** (580) 584-3321

## Contact information

- **Practice address:** 400 MAIN ST, BROKEN BOW, OK 74728-2982
- **Practice address phone:** (580) 584-3321
- **Mailing address:** 400 MAIN ST, BROKEN BOW, OK 74728-2982
- **Mailing address phone:** (580) 584-3321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/04/2022
- **Last updated:** 06/21/2023