NPI 1083346241

Mattie Elizabeth Eddleman

Practitioner General Practice Dentistry Moore, OK

Practice location

Address: 780 SW 19th St, Moore, OK 73160-3054
Phone: (402) 669-2590

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 7639 (OK)

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Registry record

NPI: 1083346241
Entity type: Individual
Sex (as registered): Female
NPI issued: 27 Jun 2022
Record last updated: 27 Jun 2022

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.