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General NPI Number Information
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NPI Number | 1164315032
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Entity Type | Organization
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Legal Business Name | MIDTOWN DENTAL STUDIO PLLC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 3150 E 41ST ST STE 141
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City | TULSA
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State | OK
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Zip | 74105-3756
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Country | US
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Telephone | 918-731-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 S BROADWAY STE 350
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City | EDMOND
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State | OK
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Zip | 73013-4040
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Country | US
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Telephone | 405-250-2255
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Fax |
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Authorized Official
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Title or Position | CHIEF GROWTH OFFICER
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Name | BRANDI ANN WILLIAMS
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Credential |
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Telephone | 405-250-2255
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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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