MEDICARE: CHARLES H MCINNIS DDS

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	3598	OK

General Provider Information

NPI Number	:	1578732434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES H MCINNIS DDS

Provider Business Mailing Address
First Line	:	8110 E 21ST ST
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 E 21ST ST
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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