Provider Demographics
NPI:1033560966
Name:MEDICAL CONSULTANT SERVICES
Entity type:Organization
Organization Name:MEDICAL CONSULTANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD, PA-C
Authorized Official - Phone:419-819-9498
Mailing Address - Street 1:3309 W PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9587
Mailing Address - Country:US
Mailing Address - Phone:419-819-9498
Mailing Address - Fax:
Practice Address - Street 1:3309 W PRINCETON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9587
Practice Address - Country:US
Practice Address - Phone:419-819-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:00000000
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-22
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty