Provider Demographics
NPI:1356590954
Name:DR. RICHARD C. CANADY, D.D.S.
Entity type:Organization
Organization Name:DR. RICHARD C. CANADY, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-523-9200
Mailing Address - Street 1:6116 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2117
Mailing Address - Country:US
Mailing Address - Phone:918-523-9200
Mailing Address - Fax:918-523-9212
Practice Address - Street 1:6116 E 61ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2117
Practice Address - Country:US
Practice Address - Phone:918-523-9200
Practice Address - Fax:918-523-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty