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General NPI Number Information
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NPI Number | 1871177188
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Entity Type | Organization
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Legal Business Name | CRANIOFACIAL PAIN TMJ & SLEEP OF OK
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 448 36TH AVE NW STE 103
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City | NORMAN
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State | OK
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Zip | 73072-4743
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Country | US
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Telephone | 405-321-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 448 36TH AVE NW STE 103
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City | NORMAN
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State | OK
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Zip | 73072-4743
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Country | US
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Telephone | 405-321-8030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYLER BRADLEY HOELZER
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Credential | DDS
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Telephone | 801-739-5915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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