Healthcare Provider Details

I. General information

NPI: 1083090229
Provider Name (Legal Business Name): IPA TULSA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 S YALE AVE SUITE 505
TULSA OK
74136-8327
US

IV. Provider business mailing address

6565 S YALE AVE SUITE 505
TULSA OK
74136-8327
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-6675
  • Fax: 918-502-6677
Mailing address:
  • Phone: 918-502-6675
  • Fax: 918-502-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3969
License Number StateOK

VIII. Authorized Official

Name: DR. THOMAS J. MCGARRY
Title or Position: OWNER
Credential: D.D.S.
Phone: 405-755-7777