Organization
WILBURTON FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CASEY OSTERHOUT DMD (PRESIDENT)
(918) 465-3535
Entity
Organization
Contact information
Practice address
114 W MAIN ST, WILBURTON, OK 74578-4044
(918) 465-2381
Mailing address
114 W MAIN ST, WILBURTON, OK 74578-4044
(918) 465-2381
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5805
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073676862
—
OK
Enumeration date
03/09/2007
Last updated
08/22/2020
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