Organization
NORTH LAKE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE SCHUMANN (CREDENTIALING SPECIALIST)
(918) 998-0996
Entity
Organization
Contact information
Practice address
12200 N MACARTHUR BLVD STE 1, OKLAHOMA CITY, OK 73162-1849
(918) 998-0996
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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