Lakecrest Dental-Owasso 96th

NPI #1972151587 in Owasso, Oklahoma

Provider Information

NPI Number: 1972151587
Entity Type: Organization
Organization Name: Lakecrest Dental-Owasso 96th
Primary Specialty: Dentist - General Practice
Enumeration Date: Aug 27, 2019
Last Updated: Oct 29, 2019

Practice Location

Address: 9551 N. OWASSO EXPRESSWAY
Address 2: SUITE #100
City: Owasso
State: Oklahoma
ZIP Code: 74055
Phone: (918) 376-6165

Authorized Official

Name: MICHELLE MAYRE MOSS
Title: OFFICE MANAGER
Phone: (918) 376-6165

Specialties & Taxonomy Codes

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

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