=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104084508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WUSE H. CARA, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2008
-----------------------------------------------------
Last Update Date | 06/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1116 NW ARLINGTON AVE
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73507-6535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-355-2345
-----------------------------------------------------
Fax | 580-353-0860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1116 NW ARLINGTON AVE
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73507-6535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-355-2345
-----------------------------------------------------
Fax | 580-353-0860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. WUSE H CARA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 580-355-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4811
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------