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General NPI Number Information
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NPI Number | 1760752901
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Entity Type | Organization
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Legal Business Name | CHRIS MASTIN ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 9118 S TOLEDO AVE
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City | TULSA
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State | OK
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Zip | 74137-2700
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Country | US
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Telephone | 918-495-1800
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Fax | 918-495-1890
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Provider Business Mailing Address
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Address Line | 9118 S TOLEDO AVE
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City | TULSA
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State | OK
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Zip | 74137-2700
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Country | US
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Telephone | 918-495-1800
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Fax | 918-495-1890
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER MASTIN
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Credential | D.D.S.
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Telephone | 918-495-1800
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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 | 5670
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License Number State | OK
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