=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689835076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN M WHENRY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2008
-----------------------------------------------------
Last Update Date | 03/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11916 S. OXFORD STE. 103
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-994-7645
-----------------------------------------------------
Fax | 918-893-4028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11916 S. OXFORD STE. 103
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-994-7645
-----------------------------------------------------
Fax | 918-893-4028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6047
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------