Healthcare Provider Details

I. General information

NPI: 1811155740
Provider Name (Legal Business Name): JAMES W HACKLER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 EAST 68TH ST 102
TULSA OK
74136
US

IV. Provider business mailing address

5010 EAST 68TH ST 102
TULSA OK
74136
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-1780
  • Fax: 918-492-7823
Mailing address:
  • Phone: 918-492-1780
  • Fax: 918-492-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3465
License Number StateOK

VIII. Authorized Official

Name: DR. JAMES W HACKLER
Title or Position: PRESIDENT
Credential: DDS
Phone: 918-492-1780