Healthcare Provider Details

I. General information

NPI: 1619199239
Provider Name (Legal Business Name): TULSA ENDODONTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 S YALE AVE SUITE 712
TULSA OK
74136-8361
US

IV. Provider business mailing address

6565 S YALE AVE SUITE 712
TULSA OK
74136-8361
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-6622
  • Fax: 918-492-0569
Mailing address:
  • Phone: 918-481-6622
  • Fax: 918-492-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5812
License Number StateOK

VIII. Authorized Official

Name: DR. AMY E STONE
Title or Position: OWNER
Credential: DDS
Phone: 918-481-6622