Provider Demographics
NPI:1083621353
Name:TOLER, SHANNON KAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KAYE
Last Name:TOLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4428
Mailing Address - Country:US
Mailing Address - Phone:918-747-6453
Mailing Address - Fax:918-382-7536
Practice Address - Street 1:611 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4428
Practice Address - Country:US
Practice Address - Phone:918-747-6453
Practice Address - Fax:918-382-7536
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice