# ELK CREEK DENTAL CENTER, PLLC

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

## Provider details

- **NPI number:** 1992541601
- **Authorized official:** DR. NATHANIEL WILLIAM TALLEY DDS (OWNER/ DENTIST)
- **Authorized official phone:** (580) 225-1020

## Contact information

- **Practice address:** 300 N GARRETT ST, ELK CITY, OK 73644
- **Practice address phone:** (580) 225-1020
- **Practice address fax:** (580) 303-7299
- **Mailing address:** 300 N GARRETT ST, ELK CITY, OK 73644
- **Mailing address phone:** (580) 225-1020
- **Mailing address fax:** (580) 303-7299

## Taxonomy

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

## Other

- **Enumeration date:** 07/02/2024
- **Last updated:** 07/08/2024