Healthcare Provider Details

I. General information

NPI: 1952401796
Provider Name (Legal Business Name): SULLIVAN, TIWANA, & RITTO ORAL & MAXILLOFACIAL SURGERY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LINCOLN BLVD STE 2000
OKLAHOMA CITY OK
73104-3252
US

IV. Provider business mailing address

1000 N LINCOLN BLVD STE 2000
OKLAHOMA CITY OK
73104-3252
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4955
  • Fax: 405-271-4525
Mailing address:
  • Phone: 405-271-4955
  • Fax: 405-271-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5062
License Number StateOK

VIII. Authorized Official

Name: AMBER PAGE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 405-271-4955