GRAND AVENUE DENTAL STUDIO NPI 1356047922

NPI Information

NPI: 1356047922
Provider Name: GRAND AVENUE DENTAL STUDIO
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
720 W GRAND AVE
CHICKASHA, OK
ZIP 73018
Phone: (405) 224-1311
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GRAND AVENUE DENTAL STUDIO is a dental clinic center in Chickasha, OK. GRAND AVENUE DENTAL STUDIO NPI is 1356047922. The provider is registered as an organization entity type.

The provider's business location address is:

720 W GRAND AVE
CHICKASHA, OK
ZIP 73018-743
Phone: (405) 224-1311
Fax: (405) 222-3654

The provider's authorized official is Tara Hanselman .
The authorized official title is Office Manager and has the following contact phone number (405) 224-1311.

The enumeration date for this NPI number is 2/6/2023 and was last updated on 2/6/2023.

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
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	14764768	OTHER	OKLAHOMA	RICHARD S. DILLON, DDS, PC

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

NPI Synchronization or Removal

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