Provider Demographics
NPI:1134387731
Name:CLINT METCALF, D.D.S., PC
Entity type:Organization
Organization Name:CLINT METCALF, D.D.S., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:T
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-624-0222
Mailing Address - Street 1:1325 S. SANGRE ROAD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-624-0222
Mailing Address - Fax:405-624-6003
Practice Address - Street 1:1325 S. SANGRE ROAD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-624-0222
Practice Address - Fax:405-624-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty