Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7471 | IA |
NPI | 1053421214 |
---|---|
Provider Name | Dr. Deborah Ann Philo-Costello |
First Address | Owasso, OK 74055-5285 |
Second Address | Claremore, OK 74017-5047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |