Organization
PAWNEE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY STARK HENDERSON D.D.S. (DENTIST)
(918) 762-3501
Entity
Organization
Contact information
Practice address
622 7TH ST, PAWNEE, OK 74058-2541
(918) 762-3501
(918) 762-2600
Mailing address
622 7TH ST, PAWNEE, OK 74058-2541
(918) 762-3501
(918) 762-2600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3796
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100053630A
—
OK
Enumeration date
01/13/2011
Last updated
01/13/2011
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