Healthcare Provider Details

I. General information

NPI: 1386091908
Provider Name (Legal Business Name): ALI SOMJEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 E 96TH ST N
OWASSO OK
74055-4767
US

IV. Provider business mailing address

13101 E 96TH ST N
OWASSO OK
74055-4767
US

V. Phone/Fax

Practice location:
  • Phone: 918-928-4747
  • Fax: 918-928-4748
Mailing address:
  • Phone: 918-928-4747
  • Fax: 918-928-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6810
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: