Organization
OKC PROSTH PLLC
Active
Other names
Southwest OKC Oklahoma Implants and Dentures
Organization subpart
No
Provider details
NPI number
Authorized official
SARA BROWN (CREDENTIALING MANAGER)
(918) 998-0996
Entity
Organization
Contact information
Practice address
11317 S WESTERN AVE STE 500, OKLAHOMA CITY, OK 73170-5851
(918) 998-0996
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
(918) 310-1056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
07/20/2021
Last updated
10/07/2021
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