Healthcare Provider Details

I. General information

NPI: 1710817473
Provider Name (Legal Business Name): TONY ABRAHAM TITTY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S MUSTANG RD
YUKON OK
73099-6186
US

IV. Provider business mailing address

800 N OKLAHOMA AVE APT 1232
OKLAHOMA CITY OK
73104-4411
US

V. Phone/Fax

Practice location:
  • Phone: 405-289-8171
  • Fax:
Mailing address:
  • Phone: 945-209-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8222
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: