Organization
MICHAEL S BEN INC PC
Active
Other names
Fairfax Dental Office
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY LYNETTE HADLOCK (OFFICE MANAGER)
(918) 642-3400
Entity
Organization
Contact information
Practice address
161 N 2ND STREET, FAIRFAX, OK 74637
(918) 642-3400
(918) 642-3370
Mailing address
161 N 2ND STREET, FAIRFAX, OK 74637
(918) 642-3400
(918) 642-3370
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003750A
—
OK
Enumeration date
12/13/2006
Last updated
02/13/2015
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