Organization
CUSTOM DENTAL SOUTH OKLAHOMA CITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARSON LOUIS NAIL DMD (DENTIST)
(405) 631-7571
Entity
Organization
Contact information
Practice address
6800 S WESTERN AVE, OKLAHOMA CITY, OK 73139-1809
(405) 631-7571
Mailing address
6800 S WESTERN AVE, OKLAHOMA CITY, OK 73139-1809
(405) 631-7571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6745
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200592780A
—
OK
Enumeration date
11/10/2015
Last updated
11/10/2015
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