Individual
MRS. KATELYN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4425 GRANT BLVD. CUSTOM DENTAL OF YUKON, YUKON, OK 73099
(405) 494-4877
(405) 494-4184
Mailing address
4425 GRANT BLVD., YUKON, OK 73099
(405) 494-4877
(405) 494-4184
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6738
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6738
STATE OF OKLAHOMA
OK
Enumeration date
07/03/2015
Last updated
10/02/2023
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