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General NPI Number Information
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NPI Number | 1952784704
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Entity Type | Individual
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Provider Name | ARTHI MATTA
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 1683 24TH AVE NW
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City | NORMAN
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State | OK
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Zip | 73069-6566
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Country | US
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Telephone | 405-698-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 14200 N MAY AVE APT #121
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-5033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6713
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License Number State | OK
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