=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114912128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL B STRAHAN DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 W 6TH ST STE 1615
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74119-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-587-1303
-----------------------------------------------------
Fax | 918-587-6360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 W 6TH ST STE 1615
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74119-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-587-1303
-----------------------------------------------------
Fax | 918-587-6360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRAD BOYD STRAHAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 918-587-1303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3783
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------