Healthcare Provider Details

I. General information

NPI: 1174669527
Provider Name (Legal Business Name): KIRKPATRICK & LAI DDS INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 S HARVARD AVE
TULSA OK
74135-3817
US

IV. Provider business mailing address

5304 S HARVARD AVE
TULSA OK
74135-3817
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-1346
  • Fax: 918-749-9151
Mailing address:
  • Phone: 918-747-1346
  • Fax: 918-749-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5020
License Number StateOK

VIII. Authorized Official

Name: DR. DOUGLAS AUSTIN KIRKPATRICK
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 918-747-1346