MEDICARE: DR. VICKI HARLESS D.D.S.

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	1223D0001X	Public Health Dentistry	4951	OK

General Provider Information

NPI Number	:	1366677601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI HARLESS D.D.S.

Provider Business Mailing Address
First Line	:	440 S HOUSTON AVE
Second Line	:	SUITE 402
City	:	TULSA
State	:	OK
Zip	:	74127-8903
Country	:	US
Telephone Number	:	918-581-2236
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 S HOUSTON AVE
Second Line	:	SUITE 402
City	:	TULSA
State	:	OK
Zip	:	74127-8903
Country	:	US
Telephone Number	:	918-581-2236
Fax Number	:

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

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	05/15/2009

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