Provider Demographics
NPI:1154019925
Name:DENTURES, IMPLANTS, AND DENTISTRY OF OKLAHOMA PLLC
Entity type:Organization
Organization Name:DENTURES, IMPLANTS, AND DENTISTRY OF OKLAHOMA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-237-6453
Mailing Address - Street 1:1730 SHEDECK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6010
Mailing Address - Country:US
Mailing Address - Phone:405-237-6453
Mailing Address - Fax:
Practice Address - Street 1:1730 SHEDECK PARKWAY
Practice Address - Street 2:SUITES #100 AND #105
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-237-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental