Individual
MATTIE ELIZABETH EDDLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
780 SW 19TH ST, MOORE, OK 73160-3054
(402) 669-2590
Mailing address
780 SW 19TH ST, MOORE, OK 73160-3054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7639
OK
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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