# MAIN STREET DENTAL ASSOCIATES

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

## Provider details

- **NPI number:** 1881860211
- **Authorized official:** THOMAS B JOURDAN (DENTIST)
- **Authorized official phone:** (918) 256-6831

## Contact information

- **Practice address:** 1306 N MAIN ST, MIAMI, OK 74354-3325
- **Practice address phone:** (918) 542-2858
- **Mailing address:** 1306 N MAIN ST, MIAMI, OK 74354-3325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5381 | OK | Yes |

## Other

- **Enumeration date:** 05/06/2008
- **Last updated:** 05/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 263477085001 | BLUE CROSS BLUE SHIELD | OK |
| 01 | — | OK5381 | DELTA | OK |