Organization
HERO DENTAL OF OKLAHOMA PC
Active
Other names
Pediatric Dental Group II, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE SOUDER (CREDENTIALING MANAGER)
(719) 649-0305
Entity
Organization
Contact information
Practice address
7715 E 91ST ST STE A, TULSA, OK 74133-6060
(918) 872-7009
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
01/28/2019
Last updated
01/28/2019
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