Individual
DR. CODY DUC VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1950 W KENOSHA ST, BROKEN ARROW, OK 74012-8944
(918) 518-1526
Mailing address
2219 E 11TH ST UNIT 204, TULSA, OK 74104-3641
(316) 680-9288
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8055
OK
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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