MEDICARE: WOODLAND DENTISTRY AND BRACES

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1376118307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND DENTISTRY AND BRACES

Provider Business Mailing Address
First Line	:	7811 E 71ST STREET SOUTH
Second Line	:	STE B
City	:	TULSA
State	:	OK
Zip	:	74133-2000
Country	:	US
Telephone Number	:	918-878-7803
Fax Number	:

Provider Business Practice Location Address
First Line	:	7811 E 71ST STREET SOUTH
Second Line	:	STE B
City	:	TULSA
State	:	OK
Zip	:	74133
Country	:	US
Telephone Number	:	918-878-7803
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN BOWMAN
Credential	:	DDS
Telephone Number	:	405-326-8004

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	02/09/2022

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