Organization
CUSTOM DENTAL OF EDMOND, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRANT PITT DDS (DENTIST)
(405) 282-6440
Entity
Organization
Contact information
Practice address
17840 N. PENN, OKLAHOMA CITY, OK 73012
(405) 282-6440
(405) 282-6785
Mailing address
17840 N PENNSYLVANIA AVE, EDMOND, OK 73012-9097
(405) 282-6440
(405) 282-6785
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5978
OK
Other
Enumeration date
01/10/2011
Last updated
09/15/2011
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