Basic Information
| Provider Information | |||||||||
| NPI: | 1811624307 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OCEAN DENTAL, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 LILAC DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730347206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057076142 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3410 W OWEN K GARRIOTT RD | ||||||||
| Address2: | |||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737034907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802420300 | ||||||||
| FaxNumber: | 5802421217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOBBLE | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT BUSINESS DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 4057076142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.