Kenosha Breeze Family Dental Pllc
NPI #1346724044 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1346724044
- Entity Type
- Organization
- Organization Name
- Kenosha Breeze Family Dental Pllc
- Primary Specialty
- Dentist
- Enumeration Date
- Sep 18, 2018
- Last Updated
- May 8, 2023
Practice Location
- Address
- 901 W KENOSHA ST
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-8918
- Phone
- (918) 258-8658
Authorized Official
- Name
- AMANDA LIGHTFOOT
- Title
- AUTHORIZED REPRESENTATIVE
- Phone
- (214) 702-0708
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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