Provider Demographics
NPI:1083090229
Name:IPA TULSA PLLC
Entity Type:Organization
Organization Name:IPA TULSA PLLC
Other - Org Name:IMPLANT AND PROSTHODONTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-755-7777
Mailing Address - Street 1:6565 S YALE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8327
Mailing Address - Country:US
Mailing Address - Phone:918-502-6675
Mailing Address - Fax:918-502-6677
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8327
Practice Address - Country:US
Practice Address - Phone:918-502-6675
Practice Address - Fax:918-502-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3969261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental