Provider Demographics
NPI:1124717988
Name:MARY TEMPLE-GOINS DDS PLLC
Entity type:Organization
Organization Name:MARY TEMPLE-GOINS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DWAYNA
Authorized Official - Last Name:TEMPLE-GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-226-8373
Mailing Address - Street 1:22716 N COUNTY ROAD 3190
Mailing Address - Street 2:
Mailing Address - City:ELMORE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73433-9289
Mailing Address - Country:US
Mailing Address - Phone:405-226-8373
Mailing Address - Fax:
Practice Address - Street 1:101 JAMESON DR
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-9561
Practice Address - Country:US
Practice Address - Phone:405-226-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1952926941Medicaid