Provider Demographics
NPI:1962523100
Name:UNIVERSITY ORAL & MAXILLOFACIAL SURGEONS
Entity type:Organization
Organization Name:UNIVERSITY ORAL & MAXILLOFACIAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-4441
Mailing Address - Street 1:1201 N STONEWALL AVE
Mailing Address - Street 2:DCS206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1214
Mailing Address - Country:US
Mailing Address - Phone:405-271-4441
Mailing Address - Fax:405-271-1134
Practice Address - Street 1:1201 NORTH STONEWALL AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117
Practice Address - Country:US
Practice Address - Phone:405-271-4441
Practice Address - Fax:405-271-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty