Organization
UNIVERSITY FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACK TIMOTHY RUDD DDS (OWNER)
(405) 844-6333
Entity
Organization
Contact information
Practice address
20 E DUNLOUP RD STE A, SHAWNEE, OK 74804-3201
(405) 275-3210
Mailing address
775 W COVELL RD STE 160, EDMOND, OK 73003-2302
(405) 844-6333
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/05/2018
Last updated
10/05/2018
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