Provider Demographics
NPI:1043325061
Name:DENTAL EXCELLENCE PC
Entity type:Organization
Organization Name:DENTAL EXCELLENCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-396-3711
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070
Mailing Address - Country:US
Mailing Address - Phone:918-396-3711
Mailing Address - Fax:918-396-1062
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070
Practice Address - Country:US
Practice Address - Phone:918-396-3711
Practice Address - Fax:918-396-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty