Organization
DENTAL LODGE, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY DWAYNE NABORS JR. D.D.S. (OWNER)
(405) 872-9597
Entity
Organization
Contact information
Practice address
305A N MAIN ST, NOBLE, OK 73068-9322
(405) 872-9597
(405) 872-5271
Mailing address
PO BOX 69, NOBLE, OK 73068-0069
(405) 872-9597
(405) 872-5271
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5955
OK
Other
Enumeration date
01/11/2010
Last updated
01/11/2010
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