Provider Demographics
NPI:1861605636
Name:DENNIS, SYEACHIA NYREAHRI (MD)
Entity type:Individual
Prefix:
First Name:SYEACHIA
Middle Name:NYREAHRI
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-587-2171
Mailing Address - Fax:918-295-6149
Practice Address - Street 1:1334 N. LANSING AVE.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5907
Practice Address - Country:US
Practice Address - Phone:918-587-2171
Practice Address - Fax:918-295-6149
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880IMedicaid
OK1275528085OtherMORTON MAIN CLINIC NPI NUMBER
OKJ23117858Medicaid
OKWCDPGOtherMEDICARE
OK200234130AMedicaid
OK100768880IMedicaid
OK1275528085OtherMORTON MAIN CLINIC NPI NUMBER