Individual
SHANE FEHRENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
101 MILLER DR, PAULS VALLEY, OK 73075-6412
(405) 238-2574
Mailing address
101 MILLER DR, PAULS VALLEY, OK 73075-6412
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7632
OK
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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