Organization
COMPLETE COSMETIC CARE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY SALAMANDRA (OFFICE MANAGER)
(918) 216-1000
Entity
Organization
Contact information
Practice address
12136 S YUKON AVE, SAPULPA, OK 74066-6621
(918) 216-1000
(918) 216-1100
Mailing address
12136 S YUKON AVE, SAPULPA, OK 74066-6621
(918) 216-1000
(918) 216-1100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6032
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200201950A
—
OK
Enumeration date
11/05/2013
Last updated
11/05/2013
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