# DENTAL LODGE, PLC

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

## Provider details

- **NPI number:** 1831429042
- **Authorized official:** DR. GARY DWAYNE NABORS JR. D.D.S. (OWNER)
- **Authorized official phone:** (405) 872-9597

## Contact information

- **Practice address:** 305A N MAIN ST, NOBLE, OK 73068-9322
- **Practice address phone:** (405) 872-9597
- **Practice address fax:** (405) 872-5271
- **Mailing address:** PO BOX 69, NOBLE, OK 73068-0069
- **Mailing address phone:** (405) 872-9597
- **Mailing address fax:** (405) 872-5271

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5955 | OK | Yes |

## Other

- **Enumeration date:** 01/11/2010
- **Last updated:** 01/11/2010