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CUSTOM DENTAL OF YUKON PLLC NPI 1164049185


NPI Information

NPI: 1164049185
Provider Name: CUSTOM DENTAL OF YUKON, PLLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
4425 GRANT BLVD
YUKON, OK
ZIP 73099
Phone: (405) 494-4856
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CUSTOM DENTAL OF YUKON, PLLC is a dental clinic center in Yukon, OK. CUSTOM DENTAL OF YUKON, PLLC NPI is 1164049185. The provider is registered as an organization entity type.

The provider's business location address is:

4425 GRANT BLVD
YUKON, OK
ZIP 73099
Phone: (405) 494-4856
Fax: (405) 494-4184

The provider's authorized official is Katelyn Johnson .
The authorized official title is Owner-doctor and has the following contact phone number (918) 839-9088.

The enumeration date for this NPI number is 6/26/2020 and was last updated on 6/26/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QD0000XClinic/CenterDentalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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