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General NPI Number Information
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NPI Number | 1720314701
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Entity Type | Organization
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Legal Business Name | TRANSITIONS WITH DIGNITY HEALTH CARE SERVICES
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 115 W 5TH ST 1703
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City | TULSA
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State | OK
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Zip | 74103-4239
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Country | US
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Telephone | 918-691-5987
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Fax | 918-289-0952
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Provider Business Mailing Address
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Address Line | 115 W 5TH ST 1703
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City | TULSA
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State | OK
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Zip | 74103-4239
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Country | US
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Telephone | 918-691-5987
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Fax | 918-289-0952
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Authorized Official
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Title or Position | CEO
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Name | DR. TAWANA BOURLIER
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Credential | D.D.S.
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Telephone | 918-851-1605
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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 | 4746
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License Number State | OK
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