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General NPI Number Information
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NPI Number | 1548556327
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Entity Type | Organization
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Legal Business Name | LAWTON ENDODONTICS
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 8504 NW CACHE RD
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City | LAWTON
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State | OK
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Zip | 73505-9604
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Country | US
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Telephone | 580-248-3636
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Fax | 580-248-3533
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Provider Business Mailing Address
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Address Line | 8504 NW CACHE RD
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City | LAWTON
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State | OK
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Zip | 73505-9604
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Country | US
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Telephone | 580-248-3636
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Fax | 580-248-3533
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY SCOTT SULLINS
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Credential | D.D.S.
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Telephone | 580-248-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 38
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License Number State | OK
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