Individual
SHANELL DENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
Mailing address
1928 N 6TH ST, PONCA CITY, OK 74601-2031
(580) 716-8487
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/20/2016
Last updated
10/20/2016
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