Provider Demographics
NPI:1548501133
Name:TULSA DENTAL IMPLANTS AND PERIODONTICS
Entity type:Organization
Organization Name:TULSA DENTAL IMPLANTS AND PERIODONTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-288-0818
Mailing Address - Street 1:8006 S 101ST EAST AVE
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4573
Mailing Address - Country:US
Mailing Address - Phone:918-288-0818
Mailing Address - Fax:
Practice Address - Street 1:9607 E 95TH CT S
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5839
Practice Address - Country:US
Practice Address - Phone:918-288-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
OK6119261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental