Healthcare Provider Details

I. General information

NPI: 1205097946
Provider Name (Legal Business Name): RYAN SCOTT ROBERTS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S HARVARD AVE STE 100
TULSA OK
74135-2611
US

IV. Provider business mailing address

4444 S HARVARD AVE STE 100
TULSA OK
74135-2611
US

V. Phone/Fax

Practice location:
  • Phone: 918-970-4944
  • Fax: 918-970-4953
Mailing address:
  • Phone: 918-970-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number84
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: