Provider Demographics
NPI:1295742328
Name:OUSLEY, LAURA B (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:OUSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 N MAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6329
Mailing Address - Country:US
Mailing Address - Phone:405-755-4450
Mailing Address - Fax:405-755-4481
Practice Address - Street 1:11205 N MAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6329
Practice Address - Country:US
Practice Address - Phone:405-755-4450
Practice Address - Fax:405-755-4481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200076450 AMedicaid