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General NPI Number Information
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NPI Number | 1235679440
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Entity Type | Organization
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Legal Business Name | TULSA PREMIER DENTISTRY, PLLC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 7891 E 108TH ST STE X4
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City | TULSA
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State | OK
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Zip | 74133-7406
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Country | US
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Telephone | 918-364-8180
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Fax |
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Provider Business Mailing Address
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Address Line | 7891 E 108TH ST STE X4
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City | TULSA
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State | OK
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Zip | 74133-7406
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Country | US
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Telephone | 918-364-8180
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Fax |
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Authorized Official
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Title or Position | DMD, OWNER
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Name | DR. RYAN COURSEY
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Credential | DMD
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Telephone | 918-364-8180
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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 | 6565
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License Number State | OK
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