Organization
HOMETOWN DENTAL OF YUKON PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY H LONG (MANAGER)
(405) 831-3202
Entity
Organization
Contact information
Practice address
1315 HOLLY AVE, YUKON, OK 73099-5407
(405) 494-8006
Mailing address
1600 E 19TH ST STE 504, EDMOND, OK 73013-6624
(405) 831-3202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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