Provider Demographics
NPI:1083832133
Name:VAN L. NOWLIN D.D.S.,M.S.D.,INC.
Entity Type:Organization
Organization Name:VAN L. NOWLIN D.D.S.,M.S.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:918-492-6464
Mailing Address - Street 1:5010 E 68TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3323
Mailing Address - Country:US
Mailing Address - Phone:918-492-6464
Mailing Address - Fax:918-492-3881
Practice Address - Street 1:5010 E 68TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3323
Practice Address - Country:US
Practice Address - Phone:918-492-6464
Practice Address - Fax:918-492-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3601, SPECIALTY- 741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty