Provider Demographics
NPI:1285975581
Name:MADILL DENTAL COMPANY
Entity type:Organization
Organization Name:MADILL DENTAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-332-9447
Mailing Address - Street 1:331 S RENNIE ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-332-9447
Mailing Address - Fax:580-332-5446
Practice Address - Street 1:804 S 1ST ST SUITE C
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446
Practice Address - Country:US
Practice Address - Phone:580-795-3360
Practice Address - Fax:580-795-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty