NPI 1336002302

Restore Dermatology Clinic LLC

Organisation Dermatology Physician Broken Arrow, OK

Practice location

Address: 4700 W Urbana St STE 100, Broken Arrow, OK 74012-5520
Phone: (539) 281-3101

Authorised official

Name: Jessica Graves
Title: Sole Member
Phone: (539) 281-3101

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X

Other Dermatology providers in Oklahoma →

Registry record

NPI: 1336002302
Entity type: Organization
NPI issued: 6 Dec 2025
Record last updated: 17 Dec 2025

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.