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General NPI Number Information
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NPI Number | 1174680896
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Entity Type | Organization
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Legal Business Name | TONY STRETESKY DDS
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1119 WALNUT DRIVE SUITE 4
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-226-2331
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Fax | 580-226-8776
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Provider Business Mailing Address
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Address Line | 1119 WALNUT DRIVE SUITE 4
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-226-2331
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Fax | 580-226-8776
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | TONY STRETESKY
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Credential | DDS
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Telephone | 580-226-2331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3907
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License Number State | OK
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