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General NPI Number Information
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NPI Number | 1134279102
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Entity Type | Organization
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Legal Business Name | TEJ D. LAD DDS INC PC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 725 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3518
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Country | US
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Telephone | 918-369-6118
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Fax | 918-369-6121
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Provider Business Mailing Address
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Address Line | 725 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3518
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Country | US
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Telephone | 918-369-6118
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Fax | 918-369-6121
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Authorized Official
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Title or Position | DOCTOR
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Name | TEJ DATTATRAYA LAD
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Credential | DDS
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Telephone | 918-369-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5667
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License Number State | OK
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