Provider Demographics
NPI:1114684636
Name:DOMIAN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DOMIAN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:DOMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:918-743-2928
Mailing Address - Street 1:1321 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2648
Mailing Address - Country:US
Mailing Address - Phone:918-743-2928
Mailing Address - Fax:918-743-2295
Practice Address - Street 1:1321 E 35TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2648
Practice Address - Country:US
Practice Address - Phone:918-743-2928
Practice Address - Fax:918-743-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental