Individual
PRISCILLA PICKENS-LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
717 S I 35 SERVICE RD STE C, MOORE, OK 73160-3190
(405) 378-4774
(405) 378-4775
Mailing address
717 S I 35 SERVICE RD STE C, MOORE, OK 73160-3190
(405) 378-4774
(405) 378-4775
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
25416
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
SPECIALTYLICENSE#189
OK
Other
Enumeration date
07/18/2007
Last updated
07/14/2020
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