Darrell R Dedrick, DDS
Individual provider Active NPI Dentist · Seiling, OK
NPI 1861716243 · NPPES record last updated Mar 15, 2010
Key facts
- NPI
- 1861716243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3050 (OK)
- Practice address
- 503 N. Main
Seiling, OK 73663 - Phone
- (580) 922-3162
- Fax
- (580) 922-3162
- NPI assigned
- Mar 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3050 | OK | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dedrick Dental LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3050 | OK | Yes |
Addresses
Primary practice location
503 N. Main
Seiling, OK 73663
Mailing address
PO Box 205
503 N Main
Seiling, OK 73663-0205
Phone (580) 922-3162
Other providers in Seiling, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.