Individual
JACOB WILLIAM BUSTER MENDENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10900 HEFNER POINTE DR, SUITE 204, OKLAHOMA CITY, OK 73120-5082
(405) 463-0044
(405) 463-0010
Mailing address
10900 HEFNER POINTE DR, SUITE 204, OKLAHOMA CITY, OK 73120-5082
(405) 463-0004
(405) 463-0010
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
148
OK
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
5823
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200185210A
—
OK
Enumeration date
02/14/2007
Last updated
12/08/2010
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