Organization
KICKINGBIRD DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY DUSSAULT (OFFICE MANAGER)
(405) 359-9696
Entity
Organization
Contact information
Practice address
1333 E DANFORTH RD, EDMOND, OK 73034-3201
(405) 359-9696
(405) 359-0808
Mailing address
1333 E DANFORTH RD, EDMOND, OK 73034-3201
(405) 359-9696
(405) 359-0808
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
OK4913
OK
Other
Enumeration date
05/27/2014
Last updated
05/27/2014
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