East 111 Family Dentistry Pllc

NPI #1649881582 in Bixby, Oklahoma

Provider Information

NPI Number: 1649881582
Entity Type: Organization
Organization Name: East 111 Family Dentistry Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Aug 13, 2020
Last Updated: Aug 13, 2020

Practice Location

Address: 8194 E 111TH ST S
City: Bixby
State: Oklahoma
ZIP Code: 74008-2421
Phone: (918) 369-6118

Authorized Official

Name: FAITH GASKINS
Title: DIRECTOR OF CREDENTIALING
Phone: (972) 869-3789

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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