Healthcare Provider Details

I. General information

NPI: 1245255058
Provider Name (Legal Business Name): TRISTANNE MARIE SPOTTSWOOD D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST 72 MDG/DS
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

13417 INVERNESS AVE
OKLAHOMA CITY OK
73120-7312
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2000
  • Fax: 405-736-2072
Mailing address:
  • Phone: 910-494-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5910
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7332
License Number StateNC

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: