Organization
DIXIELAND DENTAL, INC
Active
Other names
Nathan Shapard, DDS
Organization subpart
No
Provider details
NPI number
Authorized official
KATY SHAPARD (OFFICE MANAGER)
(405) 751-4466
Entity
Organization
Contact information
Practice address
4117 NW 122ND ST, SUITE C, OKLAHOMA CITY, OK 73120-8869
(405) 751-4466
(405) 608-0163
Mailing address
4117 NW 122ND ST, OKLAHOMA CITY, OK 73120-8869
(405) 751-4466
(405) 608-0163
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5733
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200068560A
—
OK
Enumeration date
06/24/2008
Last updated
06/24/2008
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