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Organization
MAIN STREET DENTAL ASSOCIATES
Active
Organization
MAIN STREET DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS B JOURDAN (DENTIST)
(918) 256-6831
Entity
Organization
Contact information
Practice address
1306 N MAIN ST, MIAMI, OK 74354-3325
(918) 542-2858
Mailing address
1306 N MAIN ST, MIAMI, OK 74354-3325
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5381
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263477085001
BLUE CROSS BLUE SHIELD
OK
01
—
OK5381
DELTA
OK
Enumeration date
05/06/2008
Last updated
05/06/2008
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