Provider Demographics
NPI:1982422531
Name:ELGIN DENTAL CARE PC
Entity type:Organization
Organization Name:ELGIN DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:580-492-5200
Mailing Address - Street 1:555 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538
Mailing Address - Country:US
Mailing Address - Phone:580-492-5200
Mailing Address - Fax:580-492-5201
Practice Address - Street 1:555 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-9999
Practice Address - Country:US
Practice Address - Phone:580-492-5200
Practice Address - Fax:580-492-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental