Healthcare Provider Details

I. General information

NPI: 1689613028
Provider Name (Legal Business Name): MYRON E. KATZ, DMD, MSD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 S HARVARD AVE
TULSA OK
74135-2905
US

IV. Provider business mailing address

4543 S HARVARD AVE
TULSA OK
74135-2905
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-6448
  • Fax: 918-749-7300
Mailing address:
  • Phone: 918-749-6448
  • Fax: 918-749-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3438
License Number StateOK

VIII. Authorized Official

Name: DR. MYRON E KATZ
Title or Position: ORTHODONTIST
Credential: D.M.D.
Phone: 918-749-6448