Provider Demographics
NPI:1093792798
Name:LAD, BEENA TEJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEENA
Middle Name:TEJ
Last Name:LAD
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 1:725 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3518
Mailing Address - Country:US
Mailing Address - Phone:918-528-3230
Mailing Address - Fax:918-528-3231
Practice Address - Street 1:8194 E 111TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2421
Practice Address - Country:US
Practice Address - Phone:918-369-6118
Practice Address - Fax:918-369-6121
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200074570AMedicaid