Organization
DYNAMIC DENTISTY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK KELLY (OWNER)
(405) 622-5612
Entity
Organization
Contact information
Practice address
4320 MCAULEY BLVD, OKLAHOMA CITY, OK 73120-8386
(405) 622-5612
Mailing address
4320 MCAULEY BLVD, OKLAHOMA CITY, OK 73120-8386
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5869
OK
Other
Enumeration date
10/11/2011
Last updated
10/11/2011
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