Organization
KENOSHA BREEZE FAMILY DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA LIGHTFOOT (AUTHORIZED REPRESENTATIVE)
(214) 702-0708
Entity
Organization
Contact information
Practice address
901 W KENOSHA ST, BROKEN ARROW, OK 74012-8918
(918) 258-8658
Mailing address
15660 DALLAS PKWY STE 925, DALLAS, TX 75248-3323
(214) 702-0729
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/18/2018
Last updated
05/08/2023
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