Provider Demographics
NPI:1063561819
Name:MOREHART, TINA JOY (DDS)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:JOY
Last Name:MOREHART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N WALKER AVE STE E500
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102
Mailing Address - Country:US
Mailing Address - Phone:405-208-8844
Mailing Address - Fax:405-208-8844
Practice Address - Street 1:500 N WALKER AVE STE E500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-208-8844
Practice Address - Fax:405-208-8844
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5821122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice