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General NPI Number Information
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NPI Number | 1174780696
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL CARE OF TULSA
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 5510 S MEMORIAL DR STE D
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City | TULSA
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State | OK
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Zip | 74145-9011
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Country | US
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Telephone | 918-627-6364
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Fax | 918-665-0167
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Provider Business Mailing Address
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Address Line | 5510 S MEMORIAL DR STE D
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City | TULSA
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State | OK
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Zip | 74145-9011
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Country | US
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Telephone | 918-627-6364
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Fax | 918-665-0167
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Authorized Official
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Title or Position | DOCTOR
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Name | MRS. KAREN PATE
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Credential | DMD
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Telephone | 918-627-6364
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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 | 4527
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License Number State | OK
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