Provider Demographics
NPI:1164315032
Name:MIDTOWN DENTAL STUDIO PLLC
Entity type:Organization
Organization Name:MIDTOWN DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF GROWTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-250-2255
Mailing Address - Street 1:2500 S BROADWAY STE 350
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4040
Mailing Address - Country:US
Mailing Address - Phone:405-250-2255
Mailing Address - Fax:
Practice Address - Street 1:3150 E 41ST ST STE 141
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3756
Practice Address - Country:US
Practice Address - Phone:918-731-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty