Organization
GRAND AVENUE DENTAL STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA HANSELMAN (OFFICE MANAGER)
(405) 224-1311
Entity
Organization
Contact information
Practice address
720 W GRAND AVE, CHICKASHA, OK 73018-5743
(405) 224-1311
Mailing address
720 W GRAND AVE, CHICKASHA, OK 73018-5743
(405) 224-1311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689803314
RICHARD S. DILLON, DDS, PC
OK
Enumeration date
02/06/2023
Last updated
02/06/2023
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