Provider Demographics
NPI:1013187186
Name:SOUTHARD, DENNY W (DDS)
Entity Type:Individual
Prefix:
First Name:DENNY
Middle Name:W
Last Name:SOUTHARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 S YALE AVE STE 712
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8308
Mailing Address - Country:US
Mailing Address - Phone:948-481-6622
Mailing Address - Fax:918-492-0568
Practice Address - Street 1:6565 S YALE AVE STE 712
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8308
Practice Address - Country:US
Practice Address - Phone:948-481-6622
Practice Address - Fax:918-492-0568
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics