Healthcare Provider Details

I. General information

NPI: 1083832133
Provider Name (Legal Business Name): VAN L. NOWLIN D.D.S.,M.S.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 E 68TH ST SUITE 200
TULSA OK
74136-3323
US

IV. Provider business mailing address

5010 E 68TH ST SUITE 200
TULSA OK
74136-3323
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-6464
  • Fax: 918-492-3881
Mailing address:
  • Phone: 918-492-6464
  • Fax: 918-492-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3601, SPECIALTY- 74
License Number StateOK

VIII. Authorized Official

Name: DR. VAN L. NOWLIN
Title or Position: ORTHODONTIST
Credential: D.D.S.,M.S.D.
Phone: 918-492-6464