Southeast Oklahoma Oral & Maxillofacial Surgery, Pc

LBN: Southeast Oklahoma Oral & Maxillofacial Surgery, Pc
Southeast Oklahoma Oral & Maxillofacial Surgery, Pc is an health care organization with primary practice located at 803 N Monte Vista St , Ada OK 74820-7711. The organization recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as the primary health care specialty. Southeast Oklahoma Oral & Maxillofacial Surgery, Pc can be contacted via phone (580) 332-3010, or through Boone, R. Todd via phone (580) 332-3010.

Contact Information

Primary practice address
803 N Monte Vista St Ada OK 74820-7711
Fax: (580) 332-3010
Website:
Authorized official contact:
Name: Boone, R. Todd Doctor of Dental Surgery (DDS)

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X

Profile Details

NPI number 1306839246
LBN Legal business name Southeast Oklahoma Oral & Maxillofacial Surgery, Pc
DBA Doing business as
Authorized official Boone, R. Todd Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 25th, 2005
Last updated May 6th, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306839246 NPPES
Oklahoma Other 444583300004 BCBS
Oklahoma Other 444583300003 BCBS
Oklahoma Other 787600 BCBS
Oklahoma MEDICAID 100112550A BCBS

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