Healthcare Provider Details

I. General information

NPI: 1447475348
Provider Name (Legal Business Name): TNT DENTAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 TAYLOR DRIVE
BARTLESVILLE OK
74006
US

IV. Provider business mailing address

5401 TAYLOR DRIVE
BARTLESVILLE OK
74006
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-4500
  • Fax: 918-333-4509
Mailing address:
  • Phone: 918-333-4500
  • Fax: 918-333-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE JOEL TEWIS
Title or Position: MEMBER OF PLLC
Credential: DDS
Phone: 918-289-7086