Provider Demographics
NPI:1982933545
Name:MOBILE DENTAL CARE OF OKLAHOMA, PC
Entity type:Organization
Organization Name:MOBILE DENTAL CARE OF OKLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:SELMER
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-970-3400
Mailing Address - Street 1:2314 S ROUTE 59 STE 384
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7756
Mailing Address - Country:US
Mailing Address - Phone:888-970-3400
Mailing Address - Fax:888-456-3812
Practice Address - Street 1:428451 E 1141 RD
Practice Address - Street 2:
Practice Address - City:PORUM
Practice Address - State:OK
Practice Address - Zip Code:74455-5745
Practice Address - Country:US
Practice Address - Phone:888-970-3400
Practice Address - Fax:708-429-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty