Provider Demographics
NPI:1730357674
Name:TULSA DENTAL MANAGEMENT, INC.
Entity type:Organization
Organization Name:TULSA DENTAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-446-0128
Mailing Address - Street 1:5676 W SKELLY DR
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-9144
Mailing Address - Country:US
Mailing Address - Phone:918-446-0128
Mailing Address - Fax:
Practice Address - Street 1:5676 W SKELLY DR
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-9144
Practice Address - Country:US
Practice Address - Phone:918-446-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty