Provider Demographics
NPI:1699883728
Name:NORTHWEST OKLAHOMA DENTAL SERVICES
Entity type:Organization
Organization Name:NORTHWEST OKLAHOMA DENTAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-233-2333
Mailing Address - Street 1:700 S MADISON
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7210
Mailing Address - Country:US
Mailing Address - Phone:580-233-2333
Mailing Address - Fax:580-233-5554
Practice Address - Street 1:700 S MADISON
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7210
Practice Address - Country:US
Practice Address - Phone:580-233-2333
Practice Address - Fax:580-233-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty