Provider Demographics
NPI:1215139639
Name:POLKINGHORNE, JOHN GARFIELD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARFIELD
Last Name:POLKINGHORNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N KELLY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4855
Mailing Address - Country:US
Mailing Address - Phone:405-341-4400
Mailing Address - Fax:405-359-9400
Practice Address - Street 1:601 N KELLY
Practice Address - Street 2:SUITE 104
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4855
Practice Address - Country:US
Practice Address - Phone:405-341-4400
Practice Address - Fax:405-359-9400
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist