Individual
DR. ROBERT BLAINE MONGRAIN JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
8701 S GARNETT RD, BROKEN ARROW, OK 74012-8852
(918) 250-9528
(918) 250-9529
Mailing address
8701 S GARNETT RD, BROKEN ARROW, OK 74012-8852
(918) 250-9528
(918) 250-9529
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4301
OK
Other
Enumeration date
02/27/2006
Last updated
07/08/2007
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