Provider Demographics
NPI:1093062911
Name:PEDIATRIC DENTAL PARTNERS PLLC
Entity type:Organization
Organization Name:PEDIATRIC DENTAL PARTNERS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-495-5600
Mailing Address - Street 1:5940 NW EXPRESSWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5101
Mailing Address - Country:US
Mailing Address - Phone:405-495-5600
Mailing Address - Fax:405-495-5602
Practice Address - Street 1:5940 NW EXPRESSWAY STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5101
Practice Address - Country:US
Practice Address - Phone:405-495-5600
Practice Address - Fax:405-495-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty