NPI 1013211846

Custom Dental of Edmond, PLLC

Organisation General Practice Dentistry Oklahoma City, OK

Practice location

Address: 17840 N. Penn, Oklahoma City, OK 73012
Phone: (405) 282-6440
Fax: (405) 282-6785
Mailing address: 17840 N Pennsylvania Ave, Edmond, OK 73012-9097

Authorised official

Name: Grant Pitt
Title: Dentist
Phone: (405) 282-6440

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 5978 (OK)

Other Dentist providers in Oklahoma →

Registry record

NPI: 1013211846
Entity type: Organization
NPI issued: 10 Jan 2011
Record last updated: 15 Sep 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.