Most Relevant Information
Provider Data
| NPI Number: | 1003437757 |
| Provider Name: | DOMINIQUE BURDETTE |
| Entity Type: | Individual |
| Taxonomy Code: | 124Q00000X |
| Specialty: | Dental Hygienist |
| License Number: | STUDENT |
Most Important Dates
| Enumeration Date: | 05/05/2020 |
| Last Updated: | 05/05/2020 |
Provider Practice Location
301 S J T STITES ST
SALLISAW
OK
749559302
Practice Location Phone/Fax
| Phone: | 9187759150 |
| Fax: |
Provider Mailing Location
3863 W 173RD ST N
SKIATOOK
OK
740709404
Provider Mailing Phone/Fax
| Phone: | 9186379045 |
| Fax: |