Provider Demographics
NPI:1114184629
Name:STEPHEN L VIRTUE DDS
Entity Type:Organization
Organization Name:STEPHEN L VIRTUE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIRTUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-943-8058
Mailing Address - Street 1:5100 N BROOKLINE AVE
Mailing Address - Street 2:#870
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3623
Mailing Address - Country:US
Mailing Address - Phone:405-943-8058
Mailing Address - Fax:
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:#870
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-943-8058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106350AMedicaid