Provider Demographics
NPI:1174951842
Name:DENTAL PROFESSIONALS OF OK, PC
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF OK, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:518 W I 240 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4400
Mailing Address - Country:US
Mailing Address - Phone:405-416-5280
Mailing Address - Fax:405-601-1070
Practice Address - Street 1:518 W I 240 SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4400
Practice Address - Country:US
Practice Address - Phone:405-416-5280
Practice Address - Fax:405-601-1070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF OK, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty