Healthcare Provider Details

I. General information

NPI: 1336854231
Provider Name (Legal Business Name): 32TCD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9729 E 79TH ST
TULSA OK
74133-4566
US

IV. Provider business mailing address

9729 E 79TH ST
TULSA OK
74133-4566
US

V. Phone/Fax

Practice location:
  • Phone: 918-250-5030
  • Fax: 918-254-8977
Mailing address:
  • Phone: 918-250-5030
  • Fax: 918-254-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRANDI WILLIAMS
Title or Position: VP OF GROWTH
Credential:
Phone: 405-250-2255