Healthcare Provider Details

I. General information

NPI: 1235269804
Provider Name (Legal Business Name): DAVID LEON MADDOX DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 E 68TH STREET SUITE 202
TULSA OK
74136
US

IV. Provider business mailing address

5010 E 68TH STREET SUITE 202
TULSA OK
74136
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-3500
  • Fax: 918-493-3502
Mailing address:
  • Phone: 918-493-3500
  • Fax: 918-493-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3320
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13ENDO
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: