Restore Dermatology Clinic LLC
NPI #1336002302 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1336002302
- Entity Type
- Organization
- Organization Name
- Restore Dermatology Clinic LLC
- Primary Specialty
- Dermatology
- Enumeration Date
- Dec 6, 2025
- Last Updated
- Dec 17, 2025
Practice Location
- Address
- 4700 W URBANA ST STE 100
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-5520
- Phone
- (539) 281-3101
Authorized Official
- Name
- JESSICA GRAVES, PA-C
- Title
- SOLE MEMBER
- Phone
- (539) 281-3101
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