Healthcare Provider Details

I. General information

NPI: 1871177188
Provider Name (Legal Business Name): CRANIOFACIAL PAIN TMJ & SLEEP OF OK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 36TH AVE NW STE 103
NORMAN OK
73072-4743
US

IV. Provider business mailing address

448 36TH AVE NW STE 103
NORMAN OK
73072-4743
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-8030
  • Fax:
Mailing address:
  • Phone: 405-321-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: TYLER BRADLEY HOELZER
Title or Position: OWNER
Credential: DDS
Phone: 801-739-5915