Organization
K GEORGE ELASSAL DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. K GEORGE ELASSAL DDS (PRESIDENT)
(405) 692-2722
Entity
Organization
Contact information
Practice address
11317 S WESTERN AVENUE, SUITE 100 A, OKLAHOMA CITY, OK 73170-5849
(405) 692-2722
Mailing address
11317 S WESTERN AVENUE, SUITE 100 A, OKLAHOMA CITY, OK 73170-5849
(405) 692-2722
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4541
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
332664771001
BCBS
—
01
—
677423
UNITED CONCORDIA
—
Enumeration date
08/30/2006
Last updated
08/22/2020
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