Healthcare Provider Details

I. General information

NPI: 1922300789
Provider Name (Legal Business Name): VROOME ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 S ATLANTA PL
TULSA OK
74114-1709
US

IV. Provider business mailing address

2117 S ATLANTA PL
TULSA OK
74114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 918-271-7361
  • Fax:
Mailing address:
  • Phone: 918-271-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number55967
License Number StateOK

VIII. Authorized Official

Name: DR. KYLE M VROOME
Title or Position: OWNER
Credential: D.D.S., M.S.
Phone: 918-742-7361