Healthcare Provider Details

I. General information

NPI: 1588769244
Provider Name (Legal Business Name): THOMAS OAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W 4TH ST
TAHLEQUAH OK
74464-5013
US

IV. Provider business mailing address

15 WILLOWCREEK RD
SHAWNEE OK
74801-6671
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-9100
  • Fax: 918-458-9200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4312
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: