# DENTAL LODGE OF PURCELL

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

## Provider details

- **NPI number:** 1922626639
- **Authorized official:** BENJAMIN BOWMAN (OWNER)
- **Authorized official phone:** (405) 326-8004

## Contact information

- **Practice address:** 1929 S GREEN AVE, PURCELL, OK 73080-6203
- **Practice address phone:** (405) 294-9090
- **Mailing address:** 1929 S GREEN AVE, PURCELL, OK 73080-6203

## Taxonomy

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

## Other

- **Enumeration date:** 07/09/2020
- **Last updated:** 08/25/2020