Individual
DR. PRESTON ALLEN MERCURIUS BANOUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2730 12TH AVE NW, ARDMORE, OK 73401-1271
(580) 226-0010
Mailing address
6447 RIVERDALE LN, GREENDALE, WI 53129-2853
(262) 271-2571
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
25506
OK
Other
Enumeration date
05/24/2021
Last updated
06/23/2025
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