Organization
DDSI SOUTH AEC LLC
Active
Other names
DDSI South AEC LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA J MOCK (DIRECTOR)
(405) 767-6630
Entity
Organization
Contact information
Practice address
4201 SOUTH WESTERN, STE. 4000, OKLAHOMA CITY, OK 73109-3410
(405) 632-4000
(405) 632-4073
Mailing address
4201 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3410
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0075
OK
Other
Enumeration date
06/14/2006
Last updated
02/10/2021
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