| Pediatric Dental Group Ii, Llc | |
|
7715 E 91st St Ste A Tulsa OK 74133-6060 | |
| (918) 585-3744 | |
| Not Available |
| Full Name | Pediatric Dental Group Ii, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7715 E 91st St Ste A, Tulsa, Oklahoma |
| Authorized Official Name and Position | Shaun Urbanozo (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7193232362 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Group Ii, Llc 2221 E Bijou St Ste 100 Colorado Springs CO 80909-8009 Ph: (719) 576-1850 | Pediatric Dental Group Ii, Llc 7715 E 91st St Ste A Tulsa OK 74133-6060 Ph: (918) 585-3744 |
| NPI Number | 1760864235 |
|---|---|
| Provider Enumeration Date | 06/22/2015 |
| Last Update Date | 03/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760864235 | NPI | - | NPPES |
| 3942 | Other | OK | OK DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 32 (Oklahoma) | Primary |
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