Organization
SIGNATURE DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KESA MCCONNELL-POORE D.D.S. (OWNER)
(405) 943-0123
Entity
Organization
Contact information
Practice address
2620 NW EXPRESSWAY, SUITE E, OKLAHOMA CITY, OK 73112-7281
(405) 943-0123
(405) 945-0234
Mailing address
2620 NW EXPRESSWAY, SUITE E, OKLAHOMA CITY, OK 73112-7281
(405) 943-0123
(405) 945-0234
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5877
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200084850A
—
OK
Enumeration date
04/25/2008
Last updated
04/17/2009
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