Individual
JAMIE HORACEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 KETCH CREEK CIR, LAWTON, OK 73507-9030
(580) 442-3905
Mailing address
BLDG. 652 HAMILTON RD, USA DENTAL ACTIVITY, FT. SILL, OK 73503
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2779
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124Q00000X
HYGIENE
OK
Enumeration date
01/17/2017
Last updated
01/17/2017
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