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NPI Code Detail

MEDICARE: TRI CITY ORAL SURGERY PLLC

MEDICARE: TRI CITY ORAL SURGERY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist
21223S0112XOral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number : 1366899510
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI CITY ORAL SURGERY PLLC
Provider Business Mailing Address
First Line : 2822 NW 32ND ST
Second Line :
City : NEWCASTLE
State : OK
Zip : 73065-6576
Country : US
Telephone Number : 405-474-6362
Fax Number : 405-513-6542
Provider Business Practice Location Address
First Line : 2822 NW 32ND ST
Second Line :
City : NEWCASTLE
State : OK
Zip : 73065-6576
Country : US
Telephone Number : 405-474-6362
Fax Number : 405-513-6542
Authorized Official
Title or Position : DENTIST
Name : DAYNE JENSEN
Credential : DMD
Telephone Number : 405-474-6362
Provider Enumeration Date : 05/18/2016
Last Update Date : 05/18/2016

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Directions to “TRI CITY ORAL SURGERY PLLC ” Practice Location

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