MEDICARE: SURE-BITE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		OK

General Provider Information

NPI Number	:	1164611729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURE-BITE INC.

Provider Business Mailing Address
First Line	:	8110 EAST 21ST STREET
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-1402
Country	:	US
Telephone Number	:	918-622-5700
Fax Number	:	918-622-4830

Provider Business Practice Location Address
First Line	:	8110 EAST 21ST STREET
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-1402
Country	:	US
Telephone Number	:	918-622-5700
Fax Number	:	918-622-4830

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KAREN L MOON
Credential	:
Telephone Number	:	918-622-5700

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	04/10/2020

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Directions to “SURE-BITE INC. ” Practice Location

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