Organization
MAIN STREET DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID HENRY DDS (OWNER)
(918) 479-8020
Entity
Organization
Contact information
Practice address
409 E MAIN ST, LOCUST GROVE, OK 74352-5116
(918) 845-5505
Mailing address
1707 FOREST HILL DR, CLAREMORE, OK 74017
(918) 845-5505
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6531
OK
Other
Enumeration date
02/06/2018
Last updated
03/02/2018
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