Provider Demographics
NPI:1134279102
Name:TEJ D. LAD DDS INC PC
Entity Type:Organization
Organization Name:TEJ D. LAD DDS INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEJ
Authorized Official - Middle Name:DATTATRAYA
Authorized Official - Last Name:LAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-369-6118
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:918-369-6118
Mailing Address - Fax:918-369-6121
Practice Address - Street 1:725 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3518
Practice Address - Country:US
Practice Address - Phone:918-369-6118
Practice Address - Fax:918-369-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56671223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200095240AMedicaid