Individual
MRS. KELLIE SUE OPHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
19 W INTERSTATE PKWY, SHAWNEE, OK 74804-1331
(405) 275-0675
Mailing address
208 N CHARLES AVE, MIDWEST CITY, OK 73130-3411
(405) 830-6437
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6292
OK
Other
Enumeration date
06/21/2011
Last updated
06/21/2011
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