Healthcare Provider Details

I. General information

NPI: 1710138219
Provider Name (Legal Business Name): ASHTON CREEK ORAL SURGERY SUITES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9118 S TOLEDO AVE
TULSA OK
74137-2700
US

IV. Provider business mailing address

9118 S TOLEDO AVE
TULSA OK
74137-2700
US

V. Phone/Fax

Practice location:
  • Phone: 918-495-1800
  • Fax: 918-495-1890
Mailing address:
  • Phone: 918-495-1800
  • Fax: 918-495-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAN E. PATTERSON
Title or Position: MANAGING PARTNER
Credential: D.D.S.
Phone: 918-495-1800