Provider Demographics
NPI:1699965194
Name:ENDODONTIC PRACTICE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:ENDODONTIC PRACTICE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:405-329-7936
Mailing Address - Street 1:707 24TH AVE SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3987
Mailing Address - Country:US
Mailing Address - Phone:405-329-7936
Mailing Address - Fax:405-329-1722
Practice Address - Street 1:707 24TH AVE SW
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3987
Practice Address - Country:US
Practice Address - Phone:405-329-7936
Practice Address - Fax:405-329-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKP-251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty