29th Street Dental Care

NPI #1912450842 in Chickasha, Oklahoma

Provider Information

NPI Number: 1912450842
Entity Type: Organization
Organization Name: 29th Street Dental Care
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 27, 2016
Last Updated: Jul 27, 2016

Practice Location

Address: 2900 W GRAND AVE
City: Chickasha
State: Oklahoma
ZIP Code: 73018-5112
Phone: (405) 222-0222

Authorized Official

Name: DR. JOHN C PHILLIPS III, D.D.S.
Title: OWNER
Phone: (405) 222-0222

Specialties & Taxonomy Codes

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

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