Individual
DR. LARS OLAV BOUMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
4517 MEMORIAL CIR, OKLAHOMA CITY, OK 73142-5004
(405) 755-7777
(405) 755-7169
Mailing address
4604 NW 161ST ST, EDMOND, OK 73013-3250
(405) 285-5937
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18073
TX
1223P0700X
Prosthodontics
PROSTHODONTICS 30
OK
Other
Enumeration date
09/07/2005
Last updated
09/11/2025
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