Provider Demographics
NPI:1174607261
Name:OKLAHOMA ENDODONTICS
Entity type:Organization
Organization Name:OKLAHOMA ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD PC
Authorized Official - Phone:405-843-9330
Mailing Address - Street 1:1008 NW GRAND BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118
Mailing Address - Country:US
Mailing Address - Phone:405-843-9330
Mailing Address - Fax:405-848-4048
Practice Address - Street 1:1008 NW GRAND BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-843-9330
Practice Address - Fax:405-848-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5127341223E0200X
OK4584281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty