Provider Demographics
NPI:1427455542
Name:REFRESH DENTISTRY
Entity type:Organization
Organization Name:REFRESH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-625-4395
Mailing Address - Street 1:732 W. NEW ORLEANS ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1803
Mailing Address - Country:US
Mailing Address - Phone:918-451-9066
Mailing Address - Fax:918-451-9069
Practice Address - Street 1:732 W NEW ORLEANS ST
Practice Address - Street 2:SUITE 132
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1803
Practice Address - Country:US
Practice Address - Phone:918-451-9066
Practice Address - Fax:918-451-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6209305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty