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General NPI Number Information
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NPI Number | 1972761427
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Entity Type | Organization
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Legal Business Name | WESLEY NEILL BLACK DDS PC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 6112E 61ST STREET
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-745-0500
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Fax | 918-712-9913
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Provider Business Mailing Address
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Address Line | 6112 E 61ST STREET
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-745-0500
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Fax | 918-712-9913
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. WESLEY NEILL BLACK
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Credential | DDS
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Telephone | 918-745-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5573
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License Number State | OK
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