Organization
NOVA ORAL SURGERY LLC
Active
Other names
Southeast Oklahoma Oral and Maxillofacial
Organization subpart
No
Provider details
NPI number
Authorized official
HANS CHARLES IGOU DDS (OWNER)
(580) 332-3010
Entity
Organization
Contact information
Practice address
803 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-3010
(580) 332-3010
Mailing address
803 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-3010
(580) 332-1302
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200485650A
—
OK
Enumeration date
11/23/2022
Last updated
11/23/2022
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