Provider Demographics
NPI:1861930430
Name:FORD DENTAL LAB INC
Entity type:Organization
Organization Name:FORD DENTAL LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:STOLBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-887-0502
Mailing Address - Street 1:2828 NW 57TH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-795-3169
Mailing Address - Fax:
Practice Address - Street 1:2828 NW 57TH ST
Practice Address - Street 2:307
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6814
Practice Address - Country:US
Practice Address - Phone:405-887-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDL65292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory