Organization
BAXTER SPRINGS FAMILY DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE YATES (COO)
(918) 998-0996
Entity
Organization
Contact information
Practice address
1440 PARK AVE, BAXTER SPRINGS, KS 66713-2727
(620) 856-2173
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
(918) 310-1056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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