Provider Demographics
NPI:1255413399
Name:WT DENTAL PLLC
Entity type:Organization
Organization Name:WT DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-341-3933
Mailing Address - Street 1:1222 N FLORENCE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3147
Mailing Address - Country:US
Mailing Address - Phone:918-341-3933
Mailing Address - Fax:918-342-8820
Practice Address - Street 1:1222 N FLORENCE
Practice Address - Street 2:SUITE B
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3147
Practice Address - Country:US
Practice Address - Phone:918-341-3933
Practice Address - Fax:918-342-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57781223G0001X
OK39221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200066360Medicaid