Healthcare Provider Details

I. General information

NPI: 1427058999
Provider Name (Legal Business Name): RYAN V NOWLIN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 E 68TH ST
TULSA OK
74136-3323
US

IV. Provider business mailing address

5010 E 68TH ST
TULSA OK
74136-3305
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 Number5553
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: