Provider Demographics
NPI:1194257543
Name:DENTAL PROFESSIONALS OF OKLAHOMA, PC
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF OKLAHOMA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEARTLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:9840 E 81ST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4585
Mailing Address - Country:US
Mailing Address - Phone:918-254-8686
Mailing Address - Fax:
Practice Address - Street 1:9840 E 81ST ST STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4585
Practice Address - Country:US
Practice Address - Phone:918-254-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF OKLAHOMA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty