Provider Demographics
NPI:1174885818
Name:EMAMI, JUSTIN MASSEEH (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MASSEEH
Last Name:EMAMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 S YALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7034
Mailing Address - Country:US
Mailing Address - Phone:918-496-8010
Mailing Address - Fax:918-496-9536
Practice Address - Street 1:7320 S YALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7034
Practice Address - Country:US
Practice Address - Phone:918-496-8010
Practice Address - Fax:918-496-9536
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice