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General NPI Number Information
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NPI Number | 1699951053
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Entity Type | Organization
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Legal Business Name | OKLAHOMA WISDOM TEETH CENTER
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 7316 E 91ST ST
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City | TULSA
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State | OK
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Zip | 74133-6016
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Country | US
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Telephone | 918-491-9996
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Fax | 918-491-6999
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Provider Business Mailing Address
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Address Line | 7316 E 91ST ST
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City | TULSA
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State | OK
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Zip | 74133-6016
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Country | US
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Telephone | 918-491-9996
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Fax | 918-491-6999
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Authorized Official
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Title or Position | OWNER
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Name | LLOYD A HUDSON
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Credential | DDS MD
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Telephone | 918-491-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5352
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License Number State | OK
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