Provider Demographics
NPI:1386801736
Name:DR. GEORGE A. SHUTE II D.D.S.
Entity type:Organization
Organization Name:DR. GEORGE A. SHUTE II D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHUTE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-492-7343
Mailing Address - Street 1:5314 S YALE AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6256
Mailing Address - Country:US
Mailing Address - Phone:918-492-7343
Mailing Address - Fax:918-492-7343
Practice Address - Street 1:5314 S YALE AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6256
Practice Address - Country:US
Practice Address - Phone:918-492-7343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty