Grand Avenue Dental Studio

NPI #1952007528 in Chickasha, Oklahoma

Provider Information

NPI Number: 1952007528
Entity Type: Organization
Organization Name: Grand Avenue Dental Studio
Primary Specialty: Dentist - General Practice
Enumeration Date: Feb 6, 2023
Last Updated: Feb 6, 2023

Practice Location

Address: 720 W GRAND AVE
City: Chickasha
State: Oklahoma
ZIP Code: 73018-5743
Phone: (405) 224-1311

Authorized Official

Name: TARA HANSELMAN
Title: OFFICE MANAGER
Phone: (405) 224-1311

Specialties & Taxonomy Codes

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

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