Provider Demographics
NPI:1902140197
Name:DR JIM LOUIS WEST, DDS
Entity Type:Organization
Organization Name:DR JIM LOUIS WEST, DDS
Other - Org Name:DR JIM LOUIS WEST, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-6841
Mailing Address - Street 1:9119 S TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2719
Mailing Address - Country:US
Mailing Address - Phone:918-749-6841
Mailing Address - Fax:918-749-6859
Practice Address - Street 1:9119 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2719
Practice Address - Country:US
Practice Address - Phone:918-749-6841
Practice Address - Fax:918-749-6859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R. DOUGLAS HILL, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty