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General NPI Number Information
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NPI Number | 1366552937
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Entity Type | Organization
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Legal Business Name | JOSEPH L PROSKOVEC DDS PC INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6139 EAST 91ST STREET
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City | TULSA
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State | OK
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Zip | 74137-3104
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Country | US
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Telephone | 918-491-7313
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Fax | 918-491-7314
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Provider Business Mailing Address
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Address Line | 6139 EAST 91ST STREET
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City | TULSA
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State | OK
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Zip | 74137-3104
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Country | US
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Telephone | 918-491-7313
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Fax | 918-491-7314
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | JOSEPH LEE PROSKOVEC
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Credential | DDS
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Telephone | 918-491-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5030
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License Number State | OK
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