Organization
EASTERN OKLAHOMA ORAL AND MAXILLOFACIAL SURGEONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGIE ROE (CREDENTIALING AND CONTRACTING)
(888) 247-1869
Entity
Organization
Contact information
Practice address
4716 W URBANA ST, BROKEN ARROW, OK 74012-5997
(918) 449-5800
(918) 455-8958
Mailing address
4716 W URBANA ST, BROKEN ARROW, OK 74012-5997
(918) 449-5800
(918) 455-8958
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200537790A
—
OK
05
—
200537790B
—
OK
Enumeration date
04/25/2014
Last updated
03/17/2018
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