Provider Demographics
NPI:1770731275
Name:BOARD OF REGENTS UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY
Entity type:Organization
Organization Name:BOARD OF REGENTS UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-271-5222
Mailing Address - Street 1:PO BOX 26901
Mailing Address - Street 2:ATTN OUCOD-AEGD
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0901
Mailing Address - Country:US
Mailing Address - Phone:405-271-5222
Mailing Address - Fax:405-271-3851
Practice Address - Street 1:1201 N STONEWALL AVE STE 261
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-5222
Practice Address - Fax:405-271-3851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF REGENTS UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-09
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty