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General NPI Number Information
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NPI Number | 1225653280
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Entity Type | Organization
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Legal Business Name | HENRICH DENTAL OFFICE
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 7905 E 106TH ST
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City | TULSA
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State | OK
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Zip | 74133-6802
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Country | US
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Telephone | 918-528-6555
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Fax | 918-528-6556
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Provider Business Mailing Address
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Address Line | 7905 E 106TH ST
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City | TULSA
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State | OK
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Zip | 74133-6802
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Country | US
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Telephone | 918-528-6555
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Fax | 918-528-6556
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JAMIE LEGRAND
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Credential |
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Telephone | 918-528-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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