Organization
CUSTOM DENTAL OF YUKON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATELYN JOHNSON DDS (OWNER-DOCTOR)
(918) 839-9088
Entity
Organization
Contact information
Practice address
4425 GRANT BLVD, YUKON, OK 73099
(405) 494-4856
(405) 494-4184
Mailing address
4425 GRANT BLVD, YUKON, OK 73099
(405) 494-4856
(405) 494-4184
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/26/2020
Last updated
06/26/2020
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