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General NPI Number Information
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NPI Number | 1154156172
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Entity Type | Organization
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Legal Business Name | TULSA CITY DENTAL TCD, PLLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 5639 E 41ST ST
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City | TULSA
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State | OK
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Zip | 74135-6010
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Country | US
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Telephone | 918-622-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 S JOPLIN AVE
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City | BIXBY
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State | OK
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Zip | 74008-4155
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Country | US
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Telephone | 951-533-0163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTIAN ANDRUS
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Credential | DMD
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Telephone | 951-533-0163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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