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Organization

MUSTANG FAMILY DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CALLIE D BOUZIDEN (DENTIST/OWNER)
(405) 376-3320
Entity
Organization

Contact information

Practice address
1444 N MUSTANG RD, MUSTANG, OK 73064-7214
(405) 376-3320
(405) 376-9450
Mailing address
1444 N MUSTANG RD, MUSTANG, OK 73064-7214

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6183
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1649591033
NPI
OK
01
1770996084
NPI
OK
Enumeration date
10/01/2015
Last updated
11/09/2020
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