Brent Thomas Amaya, D.D.S.

Individual provider Active NPI General Practice Dentistry · Edmond, OK

NPI 1487942876 · NPPES record last updated May 5, 2021

Key facts

NPI
1487942876
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
6273 (OK)
Practice address
2616 Exchange Dr
Edmond, OK 73034-8652
Phone
(405) 697-3828
Fax
(405) 697-3829
NPI assigned
Jul 19, 2011
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
6273OKMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6273 OK Yes

Addresses

Primary practice location

2616 Exchange Dr
Edmond, OK 73034-8652

Mailing address

2616 Exchange Dr
Edmond, OK 73034-8652
Phone (405) 697-3828

Other providers in Edmond, OK

All providers in Edmond, OK · General Practice Dentistry in Oklahoma

Sources for this page

Verify at the official NPI Registry.