Organization
SPECIALTY FACIAL PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLESETTA M THOMPSON (TECHNICIAN)
(405) 595-3226
Entity
Organization
Contact information
Practice address
229 NW 9TH ST STE 107, OKLAHOMA CITY, OK 73102-2619
(405) 620-0880
Mailing address
229 NW 9TH ST STE 107, OKLAHOMA CITY, OK 73102-2619
(405) 595-3226
(405) 600-6296
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
08/23/2018
Last updated
05/03/2019
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