| Aqua Dental | |
|
10507 E 91st Street Suite 410 Tulsa OK 74133 | |
| (918) 455-7700 | |
| (918) 455-5541 |
| Full Name | Aqua Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 10507 E 91st Street Suite 410, Tulsa, Oklahoma |
| Authorized Official Name and Position | Samuel A Owens (OWNER) |
| Authorized Official Contact | 9184557700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aqua Dental 10507 E 91st Street Suite 410 Tulsa OK 74133 Ph: (918) 455-7700 | Aqua Dental 10507 E 91st Street Suite 410 Tulsa OK 74133 Ph: (918) 455-7700 |
| NPI Number | 1548472137 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 05/21/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548472137 | NPI | - | NPPES |
| 200320440A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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