Healthcare Provider Details

I. General information

NPI: 1710413794
Provider Name (Legal Business Name): MATTHEW KEITH SAXON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 S HARVARD AVE
TULSA OK
74135-2905
US

IV. Provider business mailing address

4545 S HARVARD AVE
TULSA OK
74135-2905
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-1850
  • Fax:
Mailing address:
  • Phone: 918-749-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number93
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number33125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: