Organization
DENTAL SPECIALISTS OF EDMOND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YACOUB AL SAKKA DDS (CO-OWNER)
(405) 696-0908
Entity
Organization
Contact information
Practice address
16430 MUIRFIELD PL, EDMOND, OK 73013
(405) 696-0908
Mailing address
17705 SPARROW HAWK LN, EDMOND, OK 73012-7137
(405) 510-6853
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497023196
PROVIDER 02
OK
01
—
1568862357
PROVIDER 01
OK
Enumeration date
04/23/2020
Last updated
04/23/2020
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