Organization
RONISHA DURHAM DDS PLLC
Active
Other names
Revive Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONISHA DURHAM DDS (OWNER/DENTIST)
(405) 569-2604
Entity
Organization
Contact information
Practice address
15260 LLEYTONS CT, EDMOND, OK 73013-7301
(405) 492-7862
Mailing address
2701 N 23RD ST APT 2403, BROKEN ARROW, OK 74014-2171
(405) 569-2604
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200432880A
—
OK
Enumeration date
12/29/2022
Last updated
12/29/2022
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