Individual
CAROL MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1921 STONECIPHER BLVD, ADA, OK 74820
(580) 436-3980
(580) 421-6283
Mailing address
1921 STONECIPHER BLVD, ADA, OK 74820
(580) 436-3980
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6573
OK
122300000X
Dentist
MI2683-92
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
MI2683-92
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1748583
UNITED CONCORDIA
—
05
—
DD26832
—
AK
Enumeration date
07/22/2006
Last updated
05/20/2015
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