MEDICARE: MRS. JENNIFER SUZANNE BURKITT DOBSON

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	122300000X	Dentist	25368	OK

General Provider Information

NPI Number	:	1235340647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SUZANNE BURKITT DOBSON

Provider Business Mailing Address
First Line	:	9729 E 79TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4566
Country	:	US
Telephone Number	:	918-250-5030
Fax Number	:	918-254-8977

Provider Business Practice Location Address
First Line	:	9729 E 79TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4566
Country	:	US
Telephone Number	:	918-250-5030
Fax Number	:	918-254-8977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	05/03/2017

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